PBL 39 Flashcards
What are the lateral, medial, superior, roof and floor borders of the antecubital fossa made from?
Lateral: brachioradialis muscle
Medial: pronator teres muscle
Superior: epicondyles of the humerus
Roof: Bicipital aponeurosis, fascia, subcutaneous fat and skin
Floor: brachialis (proximally), supinator (distally)
Contents of the antecubital fossa
Really, Need, Beer, To, Be, At, My, Nicest
- Radial nerve
- Brachial tendon
- Brachial artery
- Median nerve
Arterial supply to the upper limb
Subclavian –> Axillary –> Brachial –> Radial & Ulnar
The cephalic and basilic veins are connected at the elbow by the…
Median cubital vein
What are the 5 groups of lymph nodes in the axilla?
Pectoral (anterior) Subscapular (posterior) Humeral (lateral) Central Apical
What are the 3 bones of the shoulder?
Scapula
Humerus
Clavicle
What is the joint at which the scapula articulates with the humerus?
Glenohumeral joint
What is the name of the joint at which the scapula articulates with the clavicle?
Acromioclavicular joint
What are the main landmarks of the proximal humerus?
Head Neck Greater tuberosity Lesser tuberosity Intertubercular groove Surgical neck Deltoid tuberosity
Which nerve is affected in a surgical neck fracture and what is the consequence of this?
Axillary nerve
Sergeant’s stripes loss of sensation to the shoulder tip - paralysis to the deltoid and teres minor
What are the landmarks of the distal humerus?
Lateral epicondyle Medial epicondyle Trochlear notch Olecranon fossa Capitulum
Function of the clavicle
Attach the upper limb to the trunk = shoulder girdle
- Protects the neurovascular structures supplying the upper limb
- Transmits force from the upper limb to the axial skeleton
What are the two ligaments which make up the coracoclavicular ligament?
Conoid ligament
Trapezoid ligament
The pectoral region contains 4 muscles, what are they?
- Pectoralis major
- Pectoralis minor
- Serratus anterior
- Subclavius
Action and innervation of the pectoralis major
Action: Adducts and medially rotates the upper limb and draws the scapula anteroinferiorly.
- The clavicular head also acts individually to flex the upper limb.
Innervation: Lateral and medial pectoral nerves
Action and innervation of the pectoralis minor
Action: Stabilises the scapula by drawing it anteroinferiorly against the thoracic wall.
Innervation: Medial pectoral nerve
Action and innervation of the serratus anterior
Function: Rotates the scapula, allowing the arm to be raised over 90 degrees. It also holds the scapula against the ribcage.
Innervation: Long thoracic nerve. (SALT) – LESION = WINGS
Action and innervation of the subclavius
Function: Anchors and depresses the clavicle.
Innervation: Nerve to subclavius.
What are the three main ligaments that strengthen the acromioclavicular joint?
Acromioclavicular ligament
Coracoclavicular ligaments: conoid and trapezoid
What are the extrinsic muscles of the shoulder?
Superficial: Trapezium
Superficial: Latissimus dorsi
Deep: Levator scapulae
Deep: Rhomboid major and minor
What is the innervation and action of the trapezius? Upper, middle and lower fibres.
Upper fibres: elevate the scapula and rotates it during ABduction of the arm
Middle fibres: retract the scapula
Lower fibres: pull scapula inferiorly
INNERVATION: ACCESSORY NERVE
Innervation and action of latissimus dorsi
Nerve supply: thoracodorsal nerve
Action: extends, adducts, and medially rotates the upper limb
Innervation and action of the levator scapulae?
Nerve supply: dorsal scapular nerve
Actions: elevates the scapula
What is the nerve supply and action of the rhomboid minor and major?
Nerve supply: dorsal scapular nerve
Action: retract and rotates the scapula
What are the intrinsic muscles of the shoulder?
Deltoid Teres major Teres minor Subscapularis Supraspinatus Infraspinatus
Which muscles make up the rotator cuff?
Teres minor
Supraspinatus
Infraspinatus
Subscapularis
What is the innervation and action of the deltoid?
Innervation: axillary nerve
Action: flexion and medial rotation, extension and lateral rotation, major abductor of the arm after the first 15 degrees (takes over from the supraspinatus)
What is the action and innervation of teres major?
Adducts and extends at the shoulder, and medially rotates the arm
Innervation: Lower subscapular nerve
What is the action and innervation of the supraspinatus muscle?
Abducts the arm 0-15 degrees, and assists deltoid for 15-90 degrees
INNERVATION: Suprascapular nerve
What is the action and innervation of the infraspinatus muscle?
Laterally rotates the arm
INNERVATION: Suprascapular nerve
What is the action and innervation of subscapularis?
Medially rotates the arm
Innervation: upper and lower subscapular nerves
What is the action and innervation of teres minor?
Laterally rotates the arm
Innervation: Axillary nerve
What are the muscles located in the anterior compartment of the upper arm?
Mneumonic BBC: biceps, brachialis, coracobrachialis
Where does the biceps brachii attach?
The radial tuberosity
What is the nerve supply and function of the biceps brachii
Nerve supply: musculocutanous nerve
Function: supinator and flexion of the arm at the elbow and the shoulder
What is the nerve supply and function of the coracobrachialis?
Nerve supply: musculocutaneous nerve
Function: flexion of the arm at the shoulder
What is the nerve supply and function of the brachialis?
Nerve: musculocutaneous nerve
Function: flexion at the elbow
What is the muscle in the posterior compartment of the upper arm?
Triceps brachii
What is the function and nerve supply to the triceps brachii?
Function: extension of the arm at the elbow
Nerve supply: radial nerve
What are the names of the ligaments found at the elbow?
Annular ligament
Radial collateral ligament
Ulnar collateral ligament
Which muscles does the musculocutaneous nerve innervate?
Brachialis
Biceps brachii
Corachobrachialis
Which muscles does the axillary nerve innervate?
Teres minor
Deltoid
Which muscles does the radial nerve innervate?
Triceps
Posterior compartment of forearm
Which muscles does the median nerve innervate?
Anterior compartment of forearm, thenar muscles, lateral two lumbricals
Which muscles does the ulnar nerve innervate
Small muscles of hand (apart from thenar and lateral two lumbricals)
Hypothenar muscles
Flexor carpi ulnaris
Medial half of flexor digitorum profundus
Pyschological aspects of pain: behavioural, cognitive and affective
Behavioural: fear avoidance (stay in bed to avoid pain)
Cognitive: somatisation (viewing the situation as worse than it actually is)
Affective: anxiety/depression
What are the main stages of a systematic review?
- Define a question and agreeing an objective method
- A search for relevant data from research
- Extraction of relevant date from research
- Assess the quality of data by judging it against criteria identified at first stage
- Analyse and combine data which give an overall result from all of the data
What are the main stages of a systematic review?
- Define a question and agreeing an objective method
- A search for relevant data from research
- Extraction of relevant date from research
- Assess the quality of data by judging it against criteria identified at first stage
- Analyse and combine data which give an overall result from all of the data
Why do we use systematic reviews?
- Allow us to efficiently integrate existing information and provide data for rational decision making
- Establish whether findings are consistent and can be generalised across populations
- Meta-analyses increase power and precision of estimates of treatment effects and exposure risks
- Limit bias and improve reliability & accuracy of conclusions
When is ethical approval needed for research?
- When participants are under 18 y/o
- When participants are over 18 y/o but are considered vulnerable
- When research involves access to records of personal or sensitive confidential information
- When research involves use of administrative or controlled data
A critical appraisal assesses a research study for its:
- Bias
- Applicability
- Limits
- Value
What are the 3 questions to ask for each type of research design when performing a critical appraisal?
- Are the results of the study valid?
- What are the results?
- Can I apply the results to this patient’s care?
