Upper Limb 1 Flashcards
What are the dermatitis for the following areas:
Thumb
Middle finger
Ulnar border of forearm
Neck
Thumb - C6
Middle finger - C7
Ulnar border of forearm - C8
Neck - C4
What are the reflexes associated with the following c spine levels:
C5
C6
C7
C5- biceps
C6- brachialis
C7- triceps
Lymph nodes from which locations drain into:
Axillary
Supraclavicular lymph nodes
Axillary- from cephalic
Supraclavicular- from basilic nodes
In the anterior/ clavipectoral approach to open the shoulder, what structure are most likely to be damaged?
Thoracoacromial artery
Musculocutaneous nerve
Which veins make up the brachial vein?
Radial & ulnar veins
What vein joins the basilic and cephalic veins and at what location?
Median cubical vein at the ACF
What veins make up the axillary vein?
Basilic and brachial
What veins make up the subclavian vein?
Cephalic draining into axillary vein (made of basilic and brachial veins)
Which part of the clavicle is most commonly fractured?
Middle 1/3rd of clavicle
In what order are the structures that pass from the neck into the thorax under the clavicle?
1- subclavian vein + phrenic nerve
2- anterior scalene
3- subclavian artery
4- brachial plexus
5-middle scalene
What muscle does the phrenic nerve pierce to enter the thorax
Anterior scalene
How many ligaments attach to the coracoid process and list them
3 ligaments:
-coracoacromial
-coracoclavicular (made of 2 ligaments)
Conoid + trapezoid ligaments
What muscles attach to the coracoid process?
3 muscles:
-pec minor
-coracobrachialis
-short head of biceps
Describe the pathology in subclavian steal syndrome
Block in proximal subclavian artery
Block is proximal to the start of the vertebral artery
Using the UL causes backflow of blood from the vertebral artery back towards subclavian causing reduced blood flow to the brain
What symptoms can patients with subclavian steal syndrome present with?
Syncope
Dizziness
UL claudication
What are some causes of thoracic outlet syndrome?
Can be due to:
-abnormal 1st rib
-a cervical rib
-hypertrophy of the scalene muscles
-apical lung tumour/ pancoasts tumour
What symptoms can patients with thoracic outlet syndrome present with?
VTOS- DVT, swelling
ATOS- ischaemia limb
NTOS- neuropathic pain, paresthesia along ulnar nerve distribution
What investigations can be done for suspected TOS?
MRI brachial plexus
Nerve conduction studies
CT neck
CT angiogram UL
Duplex USS
CXR
What are the landmarks of the beginning and end of the axillary artery?
Start- inferior to 1st rib
End- superior border of teres MINOR
Which structure divides the axillary artery into 3 parts?
Pec minor
What are the branches of the axillary artery?
1st part- superior thoracic
2nd part- thoracoacromial + lateral thoracic
3rd part- anterior + posterior circumflex humeral & subscapular
What are the branches of the thoracoacromial artery?
Pectoral
Acromial
Clavicular
Deltoid
Which arteries anatamose and supply the scapula? (Mention their arteries of origin)
Suprascapular artery- thyrocervical trunk of subclavian artery
Subscapular - 3rd part of axillary artery
What are the branches of the thyrocervical trunk?
Inferior thyroid
Subscapular
Ascending cervical
Transverse cervical
What are the rotator cuff muscles?
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
What are the origins and insertions of the rotator cuff muscles?
Supraspinatus- supraspinus fossa, GT
Infraspinatus- Infraspinus fossa, GT
Teres minor- lateral scapula, GT
Subscapularis- subscapular fossa, LT
Which shoulder muscles are supplied by the axillary nerve?
Deltoid
Teres minor
Which rotator cuff muscles are supplied by the suprascapular nerve?
Supraspinatus & infraspinatus
What nerve supplies the Subscapularis?
Upper and lower subscapular nerve
Which shoulder muscles cause external rotation of the arm?
Infraspinatus and teres minor
Which shoulder muscles cause internal rotation of the arm?
Subscapularis
Which muscles cause abduction of arm up to:
0-15
90 deg
>100
0-15 deg= Supraspinatus
>90= deltoid, trapezius
>100= serratus anterior
What are the nerves originating from the lateral trunk of the brachial plexus?
Lateral pectoral
Musculocutaneous
Median
Which trunk of the brachial plexus do the following nerves originate?
Medial
Posterior
Medial= ulnar, median
Posterior= axillary, radial
What are the nerves involved in Erb’s palsy?
ASMR:
Axillary
Suprascapular
Musculocutaneous
Radial
Describe how the nerves involved in Erb’s palsy affect the muscles
Axillary- teres minor= arm internally rotated
Suprascapular- Supraspinatus= adducted
Musculocutaneous- biceps= extension
Radial- forearm extensors= wrist flexed
What are the causes of Erb’s palsy
Damage to the upper trunk of brachial plexus affecting C5-C6.
Eg: neck flexed laterally during birth when baby pulled out of birth canal
Fall onto laterally flexed neck
What are the nerves and corresponding muscles affected in Klumpke’s palsy?
Ulnar + median nerves
All intrinsic hand muscles affected
Which nerve roots are affected in klumpke’s palsy?
C8-T1
What are the boundaries and contents of the quandrangular space?
Boundaries:
Sup= teres minor
Inf= teres major
Lateral= long head triceps
Medial= surgical neck humerus
Contents= axillary nerve + vessels
What are the boundaries and contents of the triangular SPACE?
Circumflex scapular vessels
What are the boundaries and contents of the triangular INTERVAL?
Radial nerve
Profounda brachial artery
What structures are at risk of injury during an anterior shoulder dislocation?
Axillary nerve
What nerve pierces the coracobrachialis muscle in the upper arm?
Musculocutaneous nerve
What is the location of the median nerve in relation to the brachial artery as it travels from proximal to distal in the upper arm?
Proximal- lateral
Crosses Anteriorly
Distal- medial to brachial artery
In ACF lateral to medial structures:
Biceps tendon
Brachial artery
Median nerve
What are the function of the muscles innervated by Musculocutaneous nerve?
Flexion
Supination
What are the motor and sensory symptoms seen with radial nerve injury at:
Above spiral groove
At spiral groove
Below spiral groove
Above spiral groove-
Unable to extend elbow + wrist
No sensation in arm + forearm dorsal
At spiral groove
Unable to extend at wrist
No sensation in forearm + hand dorsum
Below spiral groove
Unable to extend fingers
Sensation intact
What branch of the radial nerve is injured below the spiral groove?
Posterior interosseous nerve (PIN)
Why are patients able to extend AND supinate their wrist with PIN injury?
Brachioradialis and extensor carpi radialis allows weak wrist extension (not supplied by PIN)
Deep branch of radial nerve supplies supinator (deep branch becomes PIN after emerging from under supinator)
Why are patients able to feel their hannd (dorsum) with PIN injury?
PIN only gives motor supply
Superficial radial nerve provides sensory innervation and branches off before PIN
What are the muscles supplied by the PIN?
EPL, APL EPB
Extensor indicis
Extensor carpi ulnaris, extensor digiti minimi, extensor digitorum
What thumb movement is not possible when hand is flat on a table?
Abduction
What are the borders of the ACF?
Sup- imaginary line b/w condyles
Medial- pronation teres
Lateral- brachioradialis
Roof- aponeurosis
What are the contents of the ACF?
Lateral to medial
Radial nerve
Biceps tendon
Brachial artery
Median nerve
What is the most commonly injured nerve in supracondylar fractures?
Anterior interosseous nerve
What is the classification system for supracondylar fractures?
Gartlands:
1- undisplaced
2- displaced but posterior cortex inatact
3- displaced in 2-3 planes
4- complete periosteal disruption (can only assess intra-op)
Which type of supracondylar fractures need surgery and what is the surgical mx?
Gartland 2,3,4
Closed K wire fixation
What complication can occur with:
Conservative mx
K-wire fixation
Ischaemia
In supracondylar fractures
Conservative mx- malunion
K-wire fixation-ulnar nerve palsy (medial K-wire)
Ischaemia- volkman’s contracture
