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Vascular Surgery by Emi > Upper extremity > Flashcards

Upper extremity Flashcards

1
Q

Parts of axillary artery

A
  1. from 1st rib to pectoralis minor
  2. behind the pectoralis minor
  3. below pectoralis minor to teres major
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2
Q

branches of axillary artery

A
  1. superior thoracic artery
  2. thoracoacromial
  3. lateral thoracic
  4. subscapular
  5. anterior humeral circumflex
  6. posterior humeral circumflex
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3
Q

Branches of subclavian artery

A
  1. Vertebral
  2. internal mammary
  3. thyrocervical trunk
  4. costocervical trunk
  5. dorsal scapular
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4
Q

origin of deep palmar arch

A

radial artery

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5
Q

origin of superficial palmar arch

A

ulnar artery

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6
Q

most common upper arm anatomy variant

A

earl division of brachial artery (high origin of the radial , or accessory / duplicate brachial artery)

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7
Q

Parts of subclavian artery

A
  1. origin of the vessel to the medial border of scalene anterior
  2. behind the scalene anterior
  3. lateral border of scalenus anterior to the outer border of the first rib
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8
Q

Hypothenar hammer syndrome

A

repetitive trauma to the ulnar artery
artery gets injured at the hook of the hamate bone
ulnar artery aneurysm and digital arteries occlusive disease (embolization)

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9
Q

aberrant left subclavian

A

artery most common with right sided aortic arch
6 fold increase in congenital heart disease
most are asymptomatic however greater proportion has symptoms than with aberrant right subclavian artery

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10
Q

normal subclavian and axillary PSV

A

70-120cm/s

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11
Q

brachial artery PSV

A

50-100cm/s

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12
Q

radial / ulnar PSV

A

40-90cm/s

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13
Q

How do you diagnose subclavian steal

A

check for effects of reactive hyperemia. Inflate BP cuff on arm, keep inflated for 3-4 min. Increased flow to the arm after deflation will make reverse flow in vertebral arteries more pronounced

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14
Q

median nerve function

A

1) vascular branches to brachial artery –> sympathetic fibers
2) muscles: pronator teres
flexor carpi radialis
palmaris longus
flexor digitorum superficialis
flexor digitorum produnfus (lateral half)
pronator quadratus
oponens pollicis, abductor pollicis brevis, flexor policis brevis
3) motor to 1st and 2nd lumbrical muscle, thenar eminence
4) skin of palmar thumb, index, middle finger, 1/2 ring finger and neil beds of these fingers, lateral part of palm,

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15
Q

Forearm fasciotomy

A

3 anatomic compartments: dorsal (superficial muscles), volar (deep muscles) and “mobile wad” (innervated by radial nerve)

  • lazy S incision - releases the volar and dorsal compartment. May add incision on the dorsal aspect
  • full decompression requires carpal tunel release
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16
Q

Normal DBI

A

> 0.9

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17
Q

DBI indicating hemodynamically significant lesion that produces symptoms

A

<0.7

18
Q

DBI for rest pain

A

<0.4

19
Q

Most frequent cause of UE

Ischemia

A

60% embolus from the heart

20
Q

Expose second part of axillary artery

A

Divide pectoralis minor muscle

21
Q

Expose distal 3rd of axillary artery

A

Oblique incision along lateral margin of pectoralis major muscle with arm abducted 90 degrees

22
Q

Mid to distal brachial artery exposure

A

Medial incision over bicipital groove
Avoid cutaneous branches of median nerve located within the subcutaneous tissue during dissection
In use brachial sheath longitudinally
Median nerve is located superficially
Divide crossing vein branches to minimize the risk of injury to ulnar nerve

23
Q

Radical artery course

A

In oblique line from brachial artery pulse medial to biceps tendon to style is process
In midforearm artery is medial to brachioradialis and lateral to flexor Capri radialis

24
Q

Distal radial artery approach

A

Vertical incision over anatomic snuff box on dorsum of hand

Deepen incision through subcutaneous tissue and expose radial artery on the floor of the snuffbox

25
Q

Ulnar artery exposure

A

Course: from medial Eli condyle of humerus to pusiform bone.
In midforearm: beneath deep fascia between bellies of flexor digitorun laterally abd flexor carpin ulnaris medially
At wrist: artery is latera to flexor carpi ulnaris (most medial tendon palpable at the wrist)

26
Q

What nerves to look out for when exposing ulnar artery

A

Ulnar nerve on the latera aspect of artery in the distal ⅔

Palmar cutaneous branches of the ulnar nerve are superficial to the artery and should be preserved

27
Q

Interosseus artey course

A

Initial few milimitera of the common interosseus can be accessed by following ulnar artery down from brachial artery and then dividing some of the fibers of the superficial flexor digitorum - look for the large branch going latera and deep from ulnar artery
Common interosseus bifurcated into anterior and posterior interosseous proximal to forearm interosseus is membrane

28
Q

Exposure of the interpsseous artery

A

Same incision used to expose midportion ulnar arterseparate flexor carpi ulnaris from superficial flexor digitorum
Elevate superficial flexor digitorum along the median nerve and dissect along the antrior surface of flexor digitorum profundus
Elevate flexor pollicis longus towards radius to expose anterior interosseous neurovascular bundle
Posterior interosseous artery is beat approached through dorsal forearm incision along medial aspect of radius

29
Q

Duplex feature that favors subclsvian artery stenosis over occlusion

A

Early systolic deceleration in vertebral artery

30
Q

What’s quadrilateral space

A

Bordered by teres minor superiority, numeral shaft laterally, teres major inferiorly and long head of the triceps muscle medially. 20% of arterial TOS, mainly in young athletes with overhead arm motions.
Posterior humeral circumflex artery is affected

31
Q

Radical nerve

A

Originated from the posterior cord of the brachial plexus C5-8 and T1

  1. Cutaneous innervation: dorsum of the hand and 1,2,3 and lateral 4th finger; back of the arm
  2. Motor: triceps, brachioradialis, extensor carpi radialis longus and brevis, supinator, extensor digitorum, extensor carpi ulnaris, abductor policis longus, extensor pollicis longus and brevis
32
Q

Injury to radial nerve at the axillary

A

Saturday night palsy

Loss of extension of forearm, weakness of supination, loss of extension of hand and finger

Wrist drop

Loss of sensation in latera arm, posterior forear , dorsal hand

33
Q

Mid arm radial nerve injury

A

Mid shaft humerus fracture

Weakness of supination. And loss of extension of hand and fingers

Wrist drop

Loss of sensation in posterior arm, dosas hand

34
Q

Radial nerve injury at the elbow

A

Radius neck fracture, elbow dislocation

Weakness in extension of hand and loss of extension of fingers

Finger droop and partial wrist drop

No sensory deficit

35
Q

Median nerve injury above the elbow

A

Supracondylar humerus fracture

Loss of pronation of forearm, weakness in flex ion of the hand at the wrist
Loss of abduction and opposition of thumb

Ape hand deformity, benediction sign

Loss of sensation in 1,2,3 and half of 4 digits and thenar region

36
Q

Ulnar nerve

A

Sensation to 5th digit and medial half of the 4th digit

Motor: flexor carpi ulnaris, flexor digitorum profundus, hypothenar muscles (opponens, abductor, flexor digiti minimis), 3,4 lumbeical muscles, adductor policis,

37
Q

Musculocutaneous nerve

A

Coracobrachialis, biceps, brachialis,

Sensation to the latera side of the forearm from elbow to wrist

38
Q

Brachial plexus

A

Upper - C5-6
Middle - C7
Lower - C8-T1

Each trunk then splits into two (anterior and posterior) division .

Then regroup to become three cords:
Posterior (c5-8, t1)
Lateral (c5-c7)
Medial (c8-t1)

39
Q

What nerves come from the lateral cord of brachial plexus

A

Lateral pectoral
Musculocutaneous
Lateral root of median nerve

40
Q

What nerves come from posterior cord

A 
Upper scapular
Thoracodorsal
Lower subscapular
Axillary nerve
Radial nerve
41
Q

What nerves come from medial does od brachial plexus

A

Medial pectoral nerve
Medial root of the medial nerve
Medial cutaneous nerve of the arm and forearm
Ulnar nerve

Vascular Surgery by Emi (15 decks)

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