Upper Limb 1

Question 1

What forms the anterior wall of the axilla

Answer 1

Pectorals Major and Minor

Question 2

What forms the lateral wall of the axilla

Answer 2

Intertubecural Sulcus of the Humerus

Question 3

What forms the posterior wall of the axilla

Answer 3

Subscapularis

Question 4

What forms the medial wall of the axilla

Answer 4

Serratus Anterior + Thoracic wall

Question 5

How would you describe the shape of the axilla?

Answer 5

Pyramidal (square based pyramid)

Question 6

Explain the vasculature of the axilla and shoulder area using the following vessels ->brachial, brachiocephalic, axillary and subclavian arteries / cephalic, subclavian, internal jugular, superior vena cava and brachiocephalic veins.
Remember to note important landmarks and structures used to differentiate.

Answer 6

Brachiocephalic -> right subclavian (+right carotid)
Subclavian artery emerges between the anterior and middle scalene (where are the subclavian vein passes in front of the anterior scalene muscle) and passes along the top of the 1st rib.
As it reaches the lateral border of the 1st rib it becomes the axillary artery, traveling along the arm and shoulder until the level of the distal border of the teres major where it becomes the brachial artery.

The cephalic vein is found between the deltoid and pectoralis major muscles and joins with the subclavian vein prior to travelling under the pectoralis minor muscle. It also travels under the clavicle (and subclavicus muscle) and over the 1st rib but more medially than the artery. After passing anteriorly to the anterior scalene and meets the medial border of the 1st rib it joins with the internal jugular vein to form the brachiocephalic vein and this enters the thoracic cavity to join with the other one to form the SVC.

Question 7

What nerve roots contribute to the upper trunk of the brachial plexus

Answer 7

C5 C6

Question 8

What nerve roots contribute to the middle trunk of the brachial plexus

Answer 8

C7 only

Question 9

What nerve roots contribute to the lower trunk of the brachial plexus

Answer 9

C8 + T1

Question 10

What nerve roots form the brachial plexus

Answer 10

C5-8 + T1 ventral rami

Question 11

Where do the nerve roots emerge? (Also along with which blood vessel)

Answer 11

Between anterior and middle scalene muscles along with the subclavian artery

Question 12

After the trunk of the brachial plexus are formed describe what set of divisions happen next

Answer 12

Each trunk gives off a posterior branch to form the posterior cord
The upper trunk gives off an anterior branch to the lateral cord
The lower trunk gives off an anterior branch to the medial cord

Question 13

What is the nerve roots of the musculocutaneous nerve according to the brachial plexus map?

Answer 13

Lateral cord, upper and middle trunk, C5-7

Question 14

What is the actual nerve roots of the musculocutaneous nerves (ignoring the brachial plexus map)

Answer 14

C5-7 (matches)

Question 15

What is the nerve roots of the axillary nerve according to the brachial plexus map?

Answer 15

Posterior cord, all three trunks, C5-8 + T1

Question 16

What is the actual nerve roots of the axillary nerves (ignoring the brachial plexus map)

Answer 16

C5 + 6 (this is the biggest difference of the map)

Question 17

What is the nerve roots of the median nerve according to the brachial plexus map?

Answer 17

Lateral and median cord, all three trunks, C5-8 + T1

Question 18

What is the actual nerve roots of the median nerves (ignoring the brachial plexus map)

Answer 18

C6-8 + T1 (just slipping on the 5, but some individuals do sometimes have C5 branches)

Question 19

What is the nerve roots of the Radial nerve according to the brachial plexus map?

Answer 19

Posterior cord, all three trunks so C5-8 + T1

Question 20

What is the actual nerve roots of the Radial nerves (ignoring the brachial plexus map)

Answer 20

C5-8 + T1 (matches)

Question 21

What is the nerve roots of the ulnar nerve according to the brachial plexus map?

Answer 21

Medial cord, lower trunk, C8 + T1

Question 22

What is the actual nerve roots of the ulnar nerves (ignoring the brachial plexus map)

Answer 22

C8 + T1 (matches)

Question 23

What is the difference in location between the radial and ulnar arteries?

Answer 23

Radial is lateral and ulnar is medial

Question 24

What does the brachial artery turn into when it splits?

Answer 24

Radial and ulnar arteries

Question 25

Explain the subcutaneous venous drainage of the forearm and hand

Answer 25

The dorsal venous arch is found in the dorsum of the hand. This gives off two veins - the cephalic (located medially) and the basilic (located laterally). These two veins communicate via the median cubital vein in the cubical fossa of the elbow.

Question 26

What fingers does dermatome C5 innervate

Answer 26

False question -> it just innervates the should and upper area of the medial side

Question 27

What area does dermatome C6 innervate?

Answer 27

Whole length of the lateral aspect of the arm (mainly posterior in the upper arm) and the thumb and lateral wrist

Question 28

Describe dermatome C7

Answer 28

Innervates the whole middle section of the length of the posterior arm and the 2nd and 3rd fingers both anteriorly and posteriorly

Question 29

C8 dermatome innervates what fingers and where else?

Answer 29

C8 innervates the last two fingers (4 and 5) and the medial aspect of the arm.

Question 30

Does T1 dermatome touch the arm?

Answer 30

Yes, along with C5 it innervates the centre of the anterior aspect of the length of the forearm (under C5)

Question 31

If there is an infection in the arm what lymph nodes will it travel to?

Answer 31

Axillary lymph nodes

Question 32

If there is an infection in the medial aspect of the breast where will it go?

Answer 32

Internal thoracic lymph nodes

Question 33

If there is an infection in the lateral aspects of the breast where will it go?

Answer 33

Axillary

Question 34

If there is an infection in the scapula region where what lymph nodes is it likely to enlarge?

Answer 34

Axillary

Question 35

If there is an infected tattoo around the umbilicus what lymph nodes is it likely to go to? (Also mention which sides)

Answer 35

Both sides axillary and superficial inguinal lymph nodes

Question 36

If there is an infection between the shoulder and umbilicus where is it likely to go?

Answer 36

Axillary or internal thoracic

Question 37

If there is an infection in the leg where is it likely to go?

Answer 37

(Superficial or deep) Inguinal lymph nodes

Question 38

If there is an infection in the head or neck region what lymph node is most likely to enlarge?

Answer 38

Cervical chain.

Question 39

Name the two clavicle joints

Answer 39

Acromioclavicular joint | Sternoclavicular Joint

Question 40

What type of joints form with the clavicle

Answer 40

Plane / Gliding Synovial Joints

Question 41

What part of the clavicle is most likely to fracture

Answer 41

Junction of the lateral third and medial two thirds

Question 42

Name the important process/landmark next to the acromial end of the clavicle

Answer 42

Conoid Tubercle

Question 43

Explain the scapulo-humeral rhythm

Answer 43

Beyond 30 degrees abduction of the arm from anatomical position (of which is done soley by the shoulder joint) the rest of the movement is in a 2:1 ratio between the shoulder (2 degrees movement) and scapulo-thoracic (1 degree movement) for every 3 degrees moved. (Think when you raise your arm high you raise your chest)

Question 44

Name the 6 movements of the scapula

Answer 44

``` Elevation Depression Protract Retract Lateral Rotation (elevating glenoid) Medial Rotation (depressing glenoid) ```

Question 45

Name 2 muscles that elevate the scapula

Answer 45

Trapezius + Levator Scapulae | or rhomboids

Question 46

Name 2 muscles that depress the scapula

Answer 46

Serratus Anterior + Pectoralis Minor | or low fibres of the trapezius

Question 47

Name 2 muscles that protract the scapula

Answer 47

Serratus Anterior + Pectoralis Minor

Question 48

Name 2 muscles that retract the scapula

Answer 48

Trapezius + Rhomboids

Question 49

Name 2 muscles that laterally rotate the scapula (they elevate the glenoid cavity)

Answer 49

Trapezius + Serratus Anterior

Question 50

Name 2 muscles that medially rotate the scapula (they depress the glenoid cavity)

Answer 50

Levator Scapulae + Pectoralis Minor | gravity + rhomboids

Question 51

Name the structure associated to the glenoid cavity to enhance its shape and deepen its structure

Answer 51

glenoid labrum

Question 52

Name two main ligaments of the shoulder

Answer 52

Glenohumeral Ligaments Coracohumeral Ligaments Coracoacromial Ligaments (Transverse Tubecular Ligament)

Question 53

Describe the glenohumeral ligament and function

Answer 53

Arises in the glenoid cavity and places on the anatomical neck of the humerus, running along with the fibrous capsule of the joint. Its function is to support the anterior part of the joint

Question 54

Describe the coraco-acromial ligament

Answer 54

Arises in the acromion and goes to the coracoid process. Function is to stop superior displacement of the humeral head

Question 55

Coracohumaral Ligament structure and function?

Answer 55

Arises in the coracoid process and attaches to the humeral greater tubercle. Main function of this is to provide anterior support to the joint

Question 56

What tendon holds the long tendon of the head of the bicep in place?

Answer 56

The transverse trabecular ligament

Question 57

What part of the shoulder is least protected by ligaments making it weak?

Answer 57

Posterior aspect

Question 58

Name two of the main bursae in the shoulder joint

Answer 58

Subacromial & Subscapular

Question 59

What is the function of a bursa

Answer 59

To reduce friction of a joint

Question 60

What can cause supraspinatous tendinitis?

Answer 60

Racket sports causing injury to the subacromial bursa

Question 61

What bursa can communicate with the shoulder joint capsule?

Answer 61

Sub scapular Bursa

Question 62

Name the 4 rotator cuff muscles

Answer 62

Subscapularis Muscle Supraspinatous Muscle Infraspinatous Muscle Teres Minor

Question 63

What is the main function of the 4 rotator cuff muscles together?

Answer 63

Pulls the head of the humerus into the glenoid cavity to stabilise the joint

Question 64

What movement can the subscapularis muscle provide to the shoulder joint?

Answer 64

medial rotation

Question 65

What movement can the supraspinatous muscle provide to the shoulder joint

Answer 65

abduction (first 15 degrees)

Question 66

What movement can the infraspinatous muscle provide to the shoulder joint

Answer 66

Lateral rotation

Question 67

What muscle can the trees minor muscle provide to the shoulder joint

Answer 67

Lateral rotation

Question 68

What to bones does the rotator cuff muscles attach to

Answer 68

The scapula and the humerus

Question 69

Name two muscles that attach from the scapula to the humerus

Answer 69

Any of the rotator cuffs | Deltoid

Question 70

Describe the route of origin of the deltoid muscle

Answer 70

From the lateral spine of the scapula around the acromium to the first third of the clavicle

Question 71

Describe the movements the deltoid permits

Answer 71

Flexion -> anterior fibres Abduction -> middle fibres Extension -> posterior fibres

Question 72

What is the innervation of the deltoid?

Answer 72

Axillary nerve

Question 73

What is the most common injury to the axillary nerve?

Answer 73

Fracture of the humeral anatomical neck

Question 74

What signs/symptoms should you test for in this situation?

Answer 74

Loss of sensation in the inferior region of the deltoid otherwise known as the regimental badge area

Question 75

Where does the pectoralis major muscle originate and join to?

Answer 75

Arises from medial third of clavicle and sternal edge and attaches to the anterior ridge of the humeral tuberosity

Question 76

What movements can the pectoralis major muscle permit (2)

Answer 76

Adduction | Medial Rotation

Question 77

What is the name of the triangle located between the deltoid and pec major

Answer 77

Deltopectoral triangle

Question 78

What is located in the deltopectorial triangle and its clinical significance

Answer 78

Cephalic vein used for central lines

Question 79

What is the innervation of the serratus anterior?

Answer 79

long thoracic nerve

Question 80

What is the function of the serratus anterior?

Answer 80

Protracts and stabilises the scapula

Question 81

What procedure can damage the long thoracic nerve?

Answer 81

Manipulation of the glenohumeral joint

Question 82

What will happen if the long thoracic nerve is damaged

Answer 82

Winged scapula due to paralysis of the serratus anterior

Question 83

Describe the lay out of the trapezius muscle and explain why this gives it three different movement functions

Answer 83

Wide span muscle with fibres above, inline and below the scapular allowing to the elevate, retract and depress the scapula.

Question 84

What nerve innervates the scapula

Answer 84

Accessory (cranial nerve XI)

Question 85

What is the action of the teres major

Answer 85

Adducts and medially rotates the arm

Question 86

What is the action latissimus dorsi on the shoulder joint

Answer 86

Extend, adduct and medially rotate