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Year 2 > MSK HARC Lectures > Flashcards

MSK HARC Lectures Flashcards

1
Q

Brachial plexus is divided into 5 sections what are they?

A

Roots, Trunks, Divisions, Cords and Branches

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2
Q

What is the origin of the brachial plexus?

A

Anterior primary rami of C5-T1 spinal nerves

Can be prefixed (C4) or post-fixed (T2)

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3
Q

Where are the Roots, Trunks, Divisions, Cords and Branches

A
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4
Q

What are the two major nerves involved in the brachial plexus ROOTS?

A

Dorsal scapular n. :Innervates levator scapulae and rhomboids (major and minor)

Long thoracic n.: Innervates serratus anterior

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5
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6
Q

What are the two major nerves imvolved in the brachial plexus TRUNKS?

A

Suprascapular n. : Innervates supraspinatus and infraspinatus

Nerve to subclavius :Innervates subclavius

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7
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A
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8
Q

BP: Trunks split in two, forming _______ and ________ divisions

  • Divisions come together in a specific way to form the cords of the brachial plexus
  • ___nerves come from the divisions.
A

BP: Trunks split in two, forming anterior and posterior divisions

  • Divisions come together in a specific way to form the cords of the brachial plexus
  • No nerves come from the divisions.
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9
Q

BP

Three cords

Position determined by relationship with _______ _______

______ formed by the anterior divisions from upper and middle trunks

_______ formed by posterior divisions from all trunks

________ formed by anterior divisions from lower trunk

A

Three cords

Position determined by relationship with axillary artery

Lateral formed by the anterior divisions from upper and middle trunks

Posterior formed by posterior divisions from all trunks

Medial formed by anterior divisions from lower trunk

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10
Q

What are the nerves involved with BP cords?

A

Lateral pectoral n. • Innervates pectoralis major

Thoracodorsal n. • Innervates latissimus dorsi

Subscapular nerves Upper * & lower * • Innervates subscapularis and teres major (lower only)

Medial pectoral n. • Innervates pectoralis major and minor

Medial. cutaneous n. of the arm • Sensory to the arm

Medial. cutaneous n. of the forearm • Sensory to the forearm

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11
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13
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14
Q

BP Branches NERVES

A

Musculocutaneous n. • Lateral cord continuation

Axillary n. • Branch of posterior cord

Radial n. • Posterior cord continuation

Median n. • Medial & lateral cord branch union

Ulnar n. • Medial cord continuation

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15
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16
Q

What suppplies musculocataneous nerve

and what is it sensory to?

A
  • C5, C6 & C7
  • Supplies anterior arm musculature
  • Sensory to the forearm via lateral cutaneous nerve
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17
Q

What doe sthe axillary nerve suppply

and what is it sensory to>

A
  • Supplies Deltoid and Teres Minor
  • Sensory to shoulder • Deltoid badge
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18
Q

WHat are the landmarks for axillary nerve?

A

Landmarks

  • Quadrangular Space
  • Surgical neck of the humerus
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19
Q

Radial Nerve

Supply?

Sensory to?

Landmarks?

A
  • Supplies posterior arm and forearm • Extensors
  • Landmarks • Lower triangular space • Radial groove of the humerus
  • Sensory to arm, forearm and hand
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20
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21
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22
Q

Which nerve supplies these muscles?

A

Radial- triceps

Brachioradialis- musculotaneous

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23
Q

Median nerve

Supply

Landmarks

Sensorty to?

A
  • C5, C6, C7, C8 & T1
  • Supplies anterior forearm & hand
  • Landmarks • Cubital fossa • Carpal tunnel
  • Sensory to lateral hand
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24
Q

Ulnar nerve

Supply?

Landmarks

Sensory ?

A
  • C8 & T1 •Supplies anterior forearm & hand • Majority of intrinsic hand muscles
  • Landmarks • Posterior groove of medial epicondyle • Ulnar tunnel
  • Sensory to medial hand
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25
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26
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27
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28
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31
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32
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33
Q

How to remember the nerve roots?

A
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34
Q

Causes of brachial plexus injuries?

A

Caused by trauma or obstetric complication

  • Violent traction injuries around shoulder and cervical spine
  • Traffic collisions, knife and gunshot wounds
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35
Q

How are BP injuries classified?

A

root avulsion, stretch or rupture of plexal segments

Localised or whole plexus lesions

36
Q

How are BP injuries presented?

A
  • Presentation depends on severity
  • Sensory loss, weakness, pain & paralysis
37
Q

What is erbs palsy?

A
  • Erb’s palsy (Upper trunk injury)
  • Damage at Erb’s point • C5 & C6 form the upper trunk
  • Loss of shoulder movements and elbow flexion - ‘Waiter’s tip’ position
  • Unopposed medial shoulder rotators, wrist flexion and pronators
  • Finger movements intact; T1 preserved
  • Injured by sudden increase of angle between neck and shoulder
38
Q

What is Klumpke’s paralysis

A

(Lower trunk injury)

  • Damage at C8 and/or T1
  • C8 & T1 form the lower trunk
  • Loss of intrinsic hand muscle and long finger flexor movements
  • Hand paralysis and loss of forearm and hand sensation medially
  • Abduction injuries
  • Falling from height and grabbing on causing upwards pull on the lower trunk
  • Obstetric complications
39
Q

What is Flail limb?

A
  • Damage across C5-T1
  • Most common BP injury
  • Significant trauma is main cause
  • Linked to MND and ALS when non-traumatic
  • Complete loss of upper limb mobility and sensation
  • Severe muscular atrophy
  • Surgical repair difficult
40
Q

Is this Erbs, Klumpke’s or Flail

A

Flail

41
Q

Is this Erbs, Klumpke’s or Flail

A

Klumpke’s

42
Q

Is this Erbs, Klumpke’s or Flail

A

Erbs

43
Q
A
44
Q

What is the difference between surgical neck humerus fracture and humeral shaft fracture?

A

Surgical neck of humerus fracture

  • Damage to axillary n. and circumflex humeral arteries
  • Loss of deltoid and teres minor function
  • Abduction above 15 degrees lost
  • Weak flexion, extension and rotation of the shoulder

Humeral shaft fracture

  • Damage to radial n.
  • Loss of extension at elbow, wrist, hand and fingers
  • Spiral fracture most common – torsion induced injury
45
Q

What is joint dislocation?

A
  • No contact between the articular surfaces of the joint.
  • “Shoulder dislocation” - Antero-inferior dislocation of the glenohumeral joint with sub-coracoid displacement
  • “Shoulder separation” – Superior dislocation of the acromioclavicular joint
46
Q

• Subluxation is a partial dislocation in which some _______ contact is maintained.

A

• Subluxation is a partial dislocation in which some articular contact is maintained.

47
Q
  • Classic lesion presentation for three nerves
  • Radial nerve
  • Median nerve
  • Ulnar nerve
A
  • Radial nerve - Wrist drop (extensor loss)
  • Median nerve - Ape hand/median claw
  • Ulnar nerve - Ulnar claw
48
Q
A
49
Q

What are the thee common locations fro radial nerve lesion?

A
  1. Axilla compression
  2. Humerus spiral groove fracture
  3. Forearm compression (PIN syndrome)
50
Q

What are the two common locations for Ulnar nerve lesion?

A
  1. Ulnar (epicondylar) groove
  2. Ulnar tunnel (medial wrist)
51
Q

What are the two common locations for Median nerve lesion?

A
  1. Cubital fossa (elbow)
  2. Carpal Tunnel (wrist)
52
Q

General rules

Gluteal region - The _________ muscles are relatively large and play an active role in hip _______ and _______. The deep muscles are much smaller and collectively known as the _____ _______ ______ for the primary movement they enable at the hip

A

General rules

Gluteal region - The superficial muscles are relatively large and play an active role in hip extension and abduction. The deep muscles are much smaller and collectively known as the deep lateral rotators for the primary movement they enable at the hip

53
Q

The thigh - The ________ muscles enable hip ______ and knee ________; the ________ r muscles enable hip _______ and knee _____, and the medial muscles are hip adductors. Note that the body’s strongest hip flexor is the combined _________ muscle, located in the posterior abdominal wall

A

The thigh - The anterior muscles enable hip flexion and knee extension; the posterior muscles enable hip extension and knee flexion, and the medial muscles are hip adductors. Note that the body’s strongest hip flexor is the combined iliopsoas muscle, located in the posterior abdominal wall

54
Q

The leg (knee to foot) - Most of the leg muscles cross the ____ joint to act on the foot. As a rule, the anterior muscles are ________. The two lateral muscles _____ the foot. The superficial and deep posterior muscles, although separated by a layer of deep fascia, function mainly to __________ the foot. ________ some muscles cross the knee joint to flex this joint

A

The leg (knee to foot) - Most of the leg muscles cross the ankle joint to act on the foot. As a rule, the anterior muscles are dorsiflexors. The two lateral muscles evert the foot. The superficial and deep posterior muscles, although separated by a layer of deep fascia, function mainly to plantarflex the foot. Posteriorly some muscles cross the knee joint to flex this joint

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62
Q

Nerve Supply to Lower Limb

L2 to L4

Enters femoral triangle passing deep to inguinal ligament

Motor to anterior compartment (and pectineus)

Anterior cutaneous to front of thigh and knee

Long cutaneous nerve to supply skin as far as medial side of foot

Is this femoral, sciatic and obturator?

A

femoral

63
Q

Nerve Supply to Lower Limb

L2 to L4

Enters medial compartment of thigh through obturator canal

Supplies most of adductor muscles and skin on the medial aspect of thigh

Posterior branch – Obturator externus, adductor brevis and part of adductor magnus

Anterior branch – Adductor longus, gracilis, adductor brevis, contribution to pectineus

is this femoral obturator or sciatic

A

obturator

64
Q

Nerve Supply to Lower Limb

L4 to S3

Exits pelvis through greater sciatic foramen to enter posterior compartment of thigh between ischial tuberosity and the greater trochanter

Supplies all muscles in posterior compartment of thigh (lies on adductor magnus)

Branches into tibial and common fibular nerve

Tibial (motor) supplies posterior compartment and sole of foot

Common fibular (motor) supplies anterior and lateral compartments and continues into same for foot

Is it femoral obturator or sciatic

A

sciatic

65
Q

Contraction of gluteus______ and ______ on stance side prevent pelvic drop on swing side

A

Contraction of gluteus medius and minimus on stance side prevent pelvic drop on swing side

66
Q

What is Trendelenburg Gait?

A

Trendelenburg gait is an abnormal gait resulting from a defective hip abductor mechanism. The primary musculature involved is the gluteal musculature, including the gluteus medius and gluteus minimus muscles. The weakness of these muscles causes drooping of the pelvis to the contralateral side while walking

Patient uses circumduction to compensate

67
Q

Trendelenburg gait

causes?

A

Caused by muscular dystrophy, myopathy, muscle atrophy, congenital hip dysplasia, pelvic fracture

Surgery to correct alignment, physio to strengthen

68
Q
A
69
Q

What is the largest snyovial joint in the body?

A

Knee joint

70
Q

Patella helps decrease leverage and increase tendon wear

TRUE or FALSE

A

FALSE

Patella helps increase leverage and decrease tendon wea

71
Q

what is the q angle of the knee?

A

The Q-angle is the angle formed by the intersection of lines drawn from the anterior superior iliac spine to the center of the patella and from the center of the patella to the tibial tubercle

72
Q

What is a foot drop?

A

Foot drop is a muscular weakness or paralysis that makes it difficult to lift the front part of your foot and toes. It’s also sometimes called drop foot. It can cause you to drag your foot on the ground when you walk. Foot drop is a sign of an underlying problem rather than a condition itself

73
Q

what is Tibial nerve entrapment

A

Tarsal tunnel syndrome is a condition in which the tibial nerve is being compressed. This is the nerve in the ankle that allows feeling and movement to parts of the foot. Tarsal tunnel syndrome can lead to numbness, tingling, weakness, or muscle damage mainly in the bottom of the foot.

74
Q

what is calcaneal tendon rupture?

A

The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture). Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back of your lower leg

75
Q

What is Plantar Fasciitis

A

Straining and inflammation of the plantar aponeurosis

Weakness and overstretch so cannot support longitudinal arch

Frequently due to standing, walking, obesity, tight Achilles

Pain and tenderness of the sole of the foot and medial aspect

Inflammation causes most of the pain, mediated

Can cause ossification in the posterior attachment causing a calcaneal spur

Stretching, pain relief, orthotics to treat

76
Q

What is hallux valgus often referred to as?

Which joint is affected?

A

bunion

The first metatarsophalangeal joint is affected

77
Q
A
78
Q

What is hammer toe?

A

A hammertoe has an abnormal bend in the middle joint of a toe. Mallet toe affects the joint nearest the toenail. Hammertoe and mallet toe usually occur in your second, third and fourth toes. Relieving the pain and pressure of hammertoe and mallet toe may involve changing your footwear and wearing shoe inserts

Contracture occurring in second to fifth toes. Usually due to muscle/tendon imbalance. Poor fitting shoes again. Causes irritation against shoes which develop corns. Inheritance similar to bunions

79
Q

What are claw toe?

A

Claw toe is a common foot deformity in which your toes bend into a claw-like position, digging down into the soles of your shoes and creating painful calluses. People often blame claw toe on wearing shoes that squeeze your toes, such as shoes that are too short or high heels

80
Q

Claw toes are likely to affect all four toes of a foot at once, rather than one at a time

TRUE OR FALSE

A

FALSE

81
Q

What is a congential clubfoot?

A

Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which your baby’s foot is twisted out of shape or position. In clubfoot, the tissues connecting the muscles to the bone (tendons) are shorter than usual

82
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A
83
Q

Which nerve innervates rectus femoris?

A

Femoral

84
Q

Which condition is shown in the image?

A

Genu valgum

85
Q

. What condition could the injury below most likely cause?

A

Foot drop

86
Q
A

Year 2 (33 decks)

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