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ESA2 > MSK 1 Upper Limb > Flashcards

MSK 1 Upper Limb Flashcards

1
Q

What spinal nerve roots enter the brachial plexus?

A

C5, C6, C7, C8, T1

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2
Q

Which nerves form the ‘M’ structure across the Axillary nerve?

A

Musculocutaneous
Median
Ulnar

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3
Q

What spinal nerve root(s) form the Dorsal scapular nerve?

A

C5

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4
Q

Which spinal nerve roots form the Long Thoracic nerve?

A

C5, C6, C7

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5
Q

Which spinal root(s) form the suprascapular and subclavian nerves?

A

C5, C6

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6
Q

Which nerves branch form the ‘trunks’ section of the brachial plexus?

A

Suprascapular nerve

Subclavian nerve

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7
Q

Which nerves branch from the ‘roots’ section of the brachial plexus?

A

Long thoracic nerve

Dorsal scapula nerve

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8
Q

Which nerve branches from the lateral cord of the brachial plexus?

A

Lateral pectoral

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9
Q

Which nerves branch from the posterior cord of the brachial plexus?

A

Lower Subscapular
Medial Subscapular
Upper Subscapular

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10
Q

Which nerves branch from the Medial cord of the brachial plexus?

A

Medial cutaneous nerve of the arm
Medial cutaneous nerve of the forearm
Medial pectoral nerve

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11
Q

What are the 5 main branches of the brachial plexus?

A

1) Musculocutaneous nerve
2) Axillary nerve
3) Radial nerve
4) Median nerve
5) Ulnar nerve

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12
Q

What are the spinal nerve roots of the Musculocutaneous nerve?

A

C5, C6, C7

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13
Q

What are the spinal nerve roots of the Axillary nerve?

A

C5, C6

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14
Q

What are the spinal nerve roots of the Radial nerve?

A

C5, C6, C7, C8, T1

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15
Q

What are the spinal nerve roots of the Median nerve?

A

C5, C6, C7, C8, T1

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16
Q

What are the spinal nerve roots of the Ulnar nerve?

A

C8, T1

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17
Q

What does the Musculocutaneous nerve innervate?

A

Brachialis muscle
Biceps Brachii muscle
Coracobrachialis muscle
Skin of the lateral forearm (via Lateral cutaneous nerve of forearm)

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18
Q

Which nerve innervates the coracobrachialis?

A

Musculocutaneous nerve

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19
Q

Which nerve innervates the skin on the lateral edge of the forearm?

A

Lateral cutaneous nerve of the forearm (branch of the Musculocutaneous nerve)

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20
Q

What does Axillary nerve innervate?

A

Glenohumeral joint
Teres minor muscle
Deltoid muscle
Skin over the regimental patch area

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21
Q

Which nerve innervates Teres minor muscle?

A

Axillary nerve

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22
Q

Which nerve innervates the Deltoid muscle?

A

Axillary nerve

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23
Q

What does the Medial nerve innervate?

A 
1st and 2nd Lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Palmar skin
Anterior forearm EXCEPT FCU and ulnar 1/2 of FDP:
-Pronator teres
-Flexor carpi radialis
-Palmaris longus
-Flexor digitorum superficialis
-Medial 1/2 of Flexor digitorum profundus
-Pronator quadratus
-Flexor pollicis longus
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24
Q

Which nerve innervates the 1st and 2nd Lumbricals?

A

Medial nerve

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25
Q

Which nerve innervates the Palmar skin?

A

Medial nerve

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26
Q

Which intrinsic muscles of the hand are innervated by the Median nerve?

A

1st and 2nd Lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

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27
Q

What does the Radial nerve innervate?

A 
Skin of posterior upper limb
Posterior compartments of the upper limb muscles:
- Triceps brachii
- Brachioradialis
- Supinator
- Anconeus
- Extensor digitorum
- Extensor pollicis longus
- Abductor pollicis longus
- Abductor pollicis brevis
- Extensor carpi ulnaris
- Extensor carpi radialis longus
- Extensor carpi radialis brevis
- Extensor digiti minimi
- Extensor indici
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28
Q

Which nerve innervates the Extensor carpi ulnaris muscle?

A

Radial nerve

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29
Q

What does the Ulnar nerve innervate?

A 
Medial 1/2 of palmar and dorsal skin (of hand)
Flexor carpi ulnaris
Ulnar 1/2 of FDP
Dorsal and Palmar interossei 
3rd and 4th Lumbricals
Adductor pollicis
Hypothenar muscles:
- Opponens digiti minimi
- Abductor digiti minimi
- Flexor digiti minimi brevis
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30
Q

Which nerve innervates the dorsal and palmar interossei of the hand?

A

Ulnar nerve

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31
Q

Which nerve innervates the hypothenar muscles?

A

Ulnar nerve

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32
Q

What is the name of an upper brachial plexus injury (to C5-6 nerve roots)?

A

Erb’s palsy

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33
Q

Which nerve roots are damaged in Erb’s Palsy?

A

C5

C6

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34
Q

What are some possible causes of an Erb’s palsy?

A

Difficult birth (small birth canal, large baby, pulled out)
Trauma ie Motorcycle collision
= Extended angle between head and neck

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35
Q

How will someone present if they have Erb’s Palsy?

A
  • Extended, adducted and medially rotated arm

- Flexed wrist

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36
Q

Why does Erb’s Palsy cause arm to be adducted?

A

Damaged nerve roots of Supraspinatus nerve and Axillary nerve,
= Loss of Supraspinatus and Deltoid muscles, which are responsible for the first 90’ of abduction
= unopposed adduction

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37
Q

What is the name of a lower brachial plexus injury (to C8/T1 nerve roots)?

A

Klumpke’s palsy

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38
Q

Which nerve roots are damaged in Klumpke’s Palsy?

A

C8

T1

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39
Q

What are some possible causes of Klumpke’s Palsy?

A

Fall from tree and catch branch
Difficult birth (pulled out by arm)
= Hyperextension of arm

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40
Q

How will someone present if they have Klumpke’s Palsy?

A

‘Claw hand’

  • Extension of wrist
  • Hyperextension of metacarpophalangeal joints
  • Flexion at interphalangeal joints
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41
Q

Why does Klumpke’s Palsy cause hyperextension of metacarpophalangeal joints?

A

Damage to Median and Ulnar nerves causes loss of the lumbricals in the hand, allowing unopposed extension of MCP joints.

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42
Q

Which nerves are at risk during a stab wound to the axilla?

A

Axillary nerve

Musculocutaneous nerve

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43
Q

How would someone present if Radial nerve is damaged in the axilla?

A
  • Wrist drop

- Loss of sensation over posterior arm and forearm

44
Q

What forms the apex of the axilla?

A

Inferior surface of clavicle
Superior border of scapula
Lateral 1st rib edge

45
Q

What forms the base of the axilla?

A

Axillary fossa
Concave skin
Fascia
Subcutaneous fat

46
Q

What forms the anterior wall of the axilla?

A

Pectoralis major and minor

47
Q

What forms the posterior wall of the axilla?

A 
Superiorly = Subscapularis
Inferiorly = Lattisimus dorsi and Teres major
48
Q

What forms the lateral wall of the axilla?

A

Intertubecular sulcus of humerus

49
Q

What forms the medial border of the axilla?

A 
Serratus anterior
Thoracic wall (Ribs 1-4 and intercostal muscles)
50
Q

What are the contents of the axilla?

A

Axillary sheath (contains brachial plexus, axillary artery and axillary vein)
Axillary lymph nodes
Coracobrachialis
Pectoralis minor
Tendons of long and short heads of biceps brachii

51
Q

What is the superior border of the cubital fossa?

A

Imaginary line between the humeral epicondyles

52
Q

What is the lateral border of the cubital fossa?

A

Medial side of the brachioradialis

53
Q

What is the medial border of the cubital fossa?

A

Lateral side of the pronator teres

54
Q

What forms the floor of the cubital fossa?

A

Brachialis and Supinator

55
Q

What forms the roof of the cubital fossa?

A

Bicipital aponeurosis
Skin
Fascia

56
Q

Which vein runs through the roof of the cubital fossa?

A

Medial cubital vein

57
Q

Name the contents of the cubital fossa from lateral to medial:

A
  • Tendon of biceps brachii
  • Brachial artery
  • Median nerve
    (Median cubital vein also runs in roof of cubital fossa)
58
Q

Where is the weakest point of the clavicle?

A

Between the medial 2/3rd and lateral 1/3rd.

59
Q

How does someone usually appear with a clavicular fracture?

A
  • Supporting affected arm with other arm
  • Medial 2/3rds of clavicle pulled superiorly
  • Lateral 1/3rd of clavicle pulled inferiorly and medially
  • Shortened clavicle
60
Q

Why is the medial fragment of the clavicle pulled superiorly when fractured?

A

Strong sternocleidomastoid muscle pulled the broken fragment superiorly

61
Q

Why is the lateral fragment of the clavicle pulled inferiorly and medially when fractured?

A

Weight of upper limb pulls it inferiorly

Strong pectoralis major muscle pulls it medially

62
Q

What is the most common cause of a clavicular fracture?

A

Fall on outstretched hand

63
Q

Which part of the brachial plexus is at risk during a clavicular fracture?

A

Lateral and Medial cords

64
Q

What is the most common treatment for a clavicular fracture?

A

Sling

65
Q

What is the most common causes of a surgical neck fracture of the humerus?

A

Direct trauma

Fall on outstretched hand

66
Q

Which neurovascular structures are at risk during a surgical neck fracture of the humerus?

A

Axillary nerve

Anterior and Posterior Circumflex Humeral Arteries

67
Q

Which neurovascular structure is most at risk during a mid-shaft humeral fracture?

A

Radial nerve

68
Q

Which neurovascular structure is most at risk during a supra-condylar humeral fracture?

A

Median nerve

69
Q

Which neurovascular structure is most at risk during avulsion of the medial epicondyle of the humerus?

A

Ulnar nerve

70
Q

What is ‘cubital tunnel syndrome’?

A

Compression of ulnar nerve in the cubital tunnel

71
Q

Which 3 structures form the cubital tunnel?

A

1) Olecranon of the Ulna
2) Medial epicondyle of the humerus
3) Flexor carpi ulnaris tendon

72
Q

What structure passes through the cubital tunnel?

A

Ulnar nerve

73
Q

What is the difference between extrinsic and intrinsic muscles of the hand?

A

Extrinsic muscles originate from outside the hand - anterior or posterior compartments of the forearm
Intrinsic muscles originate from within the hand

74
Q

Name the muscles forming the Thenar eminence from lateral to medial:

A

Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

75
Q

Which nerve innervates the Thenar eminence

A

Median nerve

76
Q

Name the muscles forming the Hypothenar eminence:

A

Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis

77
Q

Which nerve innervates the Hypothenar eminence?

A

Ulnar nerve

78
Q

Where do the lumbricals originate from?

A

Flexor digitorum profundus

79
Q

What is the main actions of the lumbricals?

A

Flexion at the metocarpophalangeal joints

Extension at the interphalangeal joints

80
Q

What nerves innervate the lumbricals?

A

Median nerve

Ulnar nerve

81
Q

What is the main action of the palmar interossei?

A

Adduction of the digits

82
Q

What is the main action of the dorsal interossei?

A

Abduction of the digits

83
Q

What nerve innervates the interossei of the hand?

A

Ulnar nerve

84
Q

Which intrinsic muscles of the hand are missing from the following list:

  • Thenar eminence
  • Hypothenar eminence
  • Lumbricals
  • Interossei
A
  • Palmaris brevis

- Adductor pollicis

85
Q

Which nerve innervates the Palmaris brevis and Adductor pollicis muscles?

A

Ulnar nerve

86
Q

What is an Allen’s test, and why is it performed?

A

Occlusion of radial and ulnar arteries at wrist joint to test perfusion of the hand, ie before radial artery harvesting.

87
Q

Which artery enters the hand dorsally?

A

Radial artery

88
Q

What crosses the floor of the anatomical snuffbox?

A

Radial artery

89
Q

Which part of the hand is mainly supplied by the radial artery?

A

1st and 2nd digits

90
Q

Which part of the hand is mainly supplied by the ulnar artery?

A

2nd, 3rd, 4th and 5th digits

91
Q

Which artery enters the hand superior to the flexor retinaculum?

A

Ulnar artery

92
Q

What is the name of the canal through which the Ulnar artery passes to enter the hand?

A

Guyon’s canal

93
Q

What can commonly cause flexor tendon sheath inflammation?

A
  • Infection via skin wound (splinter etc)
  • Arthritis
  • Overuse
  • Diabetes
94
Q

Which flexor sheaths have a greater risk of transmitting infection through the carpal tunnel, and why?

A

Thenar and hypothenar flexor sheaths, as are continuous with radial and ulnar bursae

95
Q

Where would you test the dermatome of the spinal root C5?

A

Regimental badge area

96
Q

Where would you test the dermatome of the spinal root C6?

A

Tip of thumb

97
Q

Where would you test the dermatome of the spinal root C7?

A

Tip of middle finger

98
Q

Where would you test the dermatome of the spinal root C8?

A

Tip of index finger

99
Q

Where would you test the dermatome of the spinal root T1?

A

Middle medial anterior forearm

100
Q

Where would you test the dermatome of the spinal root T2?

A

Axilla

101
Q

How would you test the myotome for the spinal root C4?

A

Shoulder elevation

102
Q

How would you test the myotome for the spinal root C5?

A

Shoulder abduction

103
Q

How would you test the myotome for the spinal root C6?

A

Elbow flexion

104
Q

How would you test the myotome for the spinal root C7?

A

Elbow extension

105
Q

How would you test the myotome for the spinal root C8?

A

Finger flexion

106
Q

How would you test the myotome for the spinal root T1?

A

Finger abduction

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