LOCO2 Anatomy1a (Upper Limb anatomy) Flashcards
When examining the vertebral column, you should also inspect it from the side. What is the term given to an anterior curvature of the vertebral column, which may cause a ‘hunched over’ appearance? [1]
Acceptable responses: kyphosis, kyphotic
Which vertebrae have costal facets
Cervical
Thoracic
Lumbar
Sacral
Thoracic
Which vertebrae have a large vertebral body
Cervical
Thoracic
Lumbar
Sacral
Lumbar
Which vertebrae have a downward-sloping spinous process
Cervical
Thoracic
Lumbar
Sacral
Thoracic
Which vertebrae have a small vertebral foramen
Cervical
Thoracic
Lumbar
Sacral
Thoracic
Which vertebrae have a hatched shaped spinous process
Cervical
Thoracic
Lumbar
Sacral
Lumbar
Which vertebrae have bifid s spinous process
Cervical
Thoracic
Lumbar
Sacral
Cervical
Which vertebrae have long slender transverse process
Cervical
Thoracic
Lumbar
Sacral
Lumbar
Which vertebrae have long heart shaped vertebral body
Cervical
Thoracic
Lumbar
Sacral
Thoracic
Which of these is a lumbar vertebra?
Describe the structure of Atlas and Axis vertebrae [2]
Which type of joint connects Atlas & Axis? [1]
C1: known as the Atlas after the eponymous ancient Greek Titan, C1 articulates with the occipital condyles to hold up the skull. It has no vertebral body nor spinous process.
C2: known as the Axis, C2 has a specialised peg - the dens, or odontoid - which projects superiorly to articulate with C1 to form a pivot joint.
Label A [1]
Dens
C1 & C2
What is a Jefferson Fracture? [1]
bone fracture of the vertebra C1
What is Hangman’s fracture? [1]
fracture which involves the pars interarticularis of C2 on both sides, and is a result of hyperextension and distraction.
Correct! A Jefferson fracture is a burst fracture of the atlas, usually the result of axial loading injurues like diving headfirst into shallow water. This one is an example of a four-part fracture
Which structure, running in the transverse foramen, may also be affected by cervical vertebral fractures? [1]
Acceptable responses: vertebral artery, vertebral arteries
The scan below shows an MRI of the lumbar spine. Where is the fracture?
L3
Describe a wedge fracture [1]
Wedge fracture:
This fracture usually occurs in the front of the vertebra, collapsing the bone in the front of the spine and leaving the back of the same bone unchanged, which results in the vertebra taking on a wedge shape.
Label A & B of an intervertebral disc [2]
A: Nucelus pulposus
B: Annulus fibrosus
The articulation of the inferior and superior articular vertebra is known as a [] joint
Facet joint: aka zygopophysial joints
Your colleague has also has a look at the MRI and observes that the disc between L4 and L5 is herniating posteriorly. Which part of the disc moves in herniation? [1]
Acceptable responses: nucleus pulposus
State the innervation of pectoralis major [2]
Innervation: medial and lateral pectoral nerves.
Look at the x-ray below. Which bone is fractured? [1]
Acceptable responses: clavicle, collarbone, collar bone, the clavicle
Pectoralis major and latissimus dorsi are both adductors of the shoulder, and they attach to the proximal humerus. Normally, the clavicle holds the arm laterally away from the body, but this fracture causes it to collapse. The humerus is pulled medially, dragging the lateral fragment of clavicle with it.
What sort of injury is shown in the x-ray below? [1]
Acceptable responses: dislocation, dislocated shoulder, shoulder dislocation, anterior shoulder dislocation, anterior dislocation of shoulder, dislocation of glenohumeral joint, anterior dislocation of glenohumeral joint
Numbness ovre point of deltoid insertion
The axillary nerve is motor deltoid and teres minor. Therefore, damage may lead to weakness of these muscles, causing difficulty primarily in abduction of the shoulder. The sensory distribution of the axillary nerve is over the deltoid insertion, so damage may cause numbness in this area.
Which nerves supply the:
supraspinatous [1]
infraspinatous [1]
teres minor [1]
subscapularis [2]
supraspinatous: suprascapular nerve
infraspinatous: suprascapular nerve
teres minor: axillary nerve
subscapularis: upper & lower subscapular nerves
Which rotator cuff is innervated by the axillary nerve:
supraspinatous
infraspinatous
teres minor
subscapularis
Which rotator cuff is innervated by the axillary nerve:
supraspinatous
infraspinatous
teres minor
subscapularis
Which rotator cuff medially rotates the shoulder
supraspinatous
infraspinatous
teres minor
subscapularis
subscapularis
infraspinatous
teres minor are both lateral rotators
Which rotator cuff iniates the first 10-15 degrees of shoulder abduction
supraspinatous
infraspinatous
teres minor
subscapularis
supraspinatous
On the MRI below, a tendon passing deep to the acromion appears thickened and abnormally bright. To which muscle does this tendon belong? [1]
Acceptable responses: supraspinatus
Which disease makes fractures more common in the elderly? [1]
osteoporosis
Which structure is most at risk in the injury below? [1]
radial nerve
wrist drop
The radial nerve supplies all of the extensors of the upper limb. When it is damaged in the arm, the extensors of the elbow, wrist and digits lose power - the most noticeable deficit being difficulty extending the wrist against gravity. When the upper limbs are held out in front (as if riding a bicycle), the week wrist extensors are unable to support the weight of the hand, and the wrist ‘drops’.
The radial nerve runs speficically in which part of the humerus? [1]
The main associated injury is the radial nerve, which runs in the spiral groove on the posterior surface of the humeral shaft.
Which structure(s) is (are) most at risk in a supracondylar fracture? [2]
median nerve & brachial artery
Which structure(s) is (are) most at risk in the injury below? Select all that apply.
Why the brachail pulse area is not good: However, in the context of acute injury like this, there is likely to be a lot of swelling here, and it may not be possible to palpate it. Furthermore, successfully palpating it here will not tell you whether the flow is preserved distally
2
What is the name for this sign? [1]
Which nerve is a damged to cause this sign? [1]
Hand of Benediction; ulnar nerve damage
Which structure is most at risk in the injury below? [1]
There is a fracture of the medial epicondyle. The ulnar nerve is closely associated with the medial epicondyle as it travels posterior to it in the cubital tunnel. Therefore ulnar nerve involvement is possible, especially where there is posterior displacement of the fragment.
Which structure is most at risk in the injury below? [1]
There is a fracture of the medial epicondyle. The ulnar nerve is closely associated with the medial epicondyle as it travels posterior to it in the cubital tunnel. Therefore ulnar nerve involvement is possible, especially where there is posterior displacement of the fragment.
Explain the ulnar paradox
Ulnar paradox
* Although a proximal lesion results in denervation of more muscle, the resting appearance of the hand is better.
Proximal lesions of the ulnar
* compromise ulnar supply to the hand, but also to the forearm (flexor carpi ulnaris and the medial half of FDP).
* although in a proximal lesion lumbricals 4 and 5 are still weak, the additional weakness of FDP acting on these digits effectively ‘cancels out’ the flexion deformity of the claw hand
Distal ulnar nerve lesion:
* When the ulnar nerve is damaged, lumbricals 4 and 5 become weak and unable to do their job, so what we see instead (at rest) is extension at the MCP joints and flexion at the interphalangeal joints. This appearance is often described as the ulnar claw.
Describe what a Colles fracture is [1]
Colles fracture
* extra-articular (not involving the joint) fracture of the distal radius with dorsal angulation and impaction.
Describe what a Colles fracture is [1]
Colles fracture
* extra-articular (not involving the joint) fracture of the distal radius with dorsal angulation and impaction.
If left to heal without treatement, what deformity does a colles fracture cause? [1]
Dinner fork deformity
An anteriorly angulated distal radius fracture is more commonly referred to as a [] Fracture.
Smith fracture
Describe what a Smith fracture looks like [2]
extra-articular fracture of the distal radius with volar (anterior) angulation and impaction.
If allowed to heal with volar angulation, a Smith fracture can give rise to the so-called ‘[] deformity’.
Garden spade deformity
Ollie, a 28-year-old man, falls onto his outstretched right hand while playing touch rugby at the weekend. He attends A&E with wrist pain and there is tenderness in the anatomical snuffbox on examination.
Which bone forms the majority of the floor of the anatomical snuffbox? [1]
Acceptable responses: scaphoid, scaphoid bone
2: extensor pollicis longus, forming the medial border of the anatomical snuffbox
Ollie has his x-ray (below). Where is the fracture?
Acceptable responses: scaphoid, scaphoid bone
Nonunion and malunion are reasonably common complications of scaphoid fractures, particularly those affecting the proximal third of the scaphoid.
What is the reason for this? [1]
Blood flow is distal to proximal
The blood supply to the scaphoid comes almost entirely via its distal pole - by the dorsal carpal branch of the radial artery. This means the more proximal you go, the weaker the blood supply. Fractures need lots of blood to heal effectively, so proximal fractures have a higher risk of aberrant healing.
Due to the common mechanism of the injury, which bone also may break if a scaphoid is fractured? [1]
Disatl radius fracture
Patients with scaphoid fractures typically present with pain in which anatomical reagion? [1]
Anatomical snuffbox
