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Upper limb > Upper limb 1 > Flashcards

Upper limb 1 Flashcards

1
Q

Where is the axilla? And at what junction?

A

Below the glenohumeral joint - at the junction between the upper limb and thorax

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2
Q

What is so important about the axilla?

A

It is a passageway through which many neurovascular structures and muscular structures enter the upper limb

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3
Q

What are the 5 borders of the axilla?

A
  • Apex (axillary inlet)
  • Lateral
  • Medial
  • Anterior
  • Posterior
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4
Q

What is the apex border?

A
  • Lateral border of the first rib
  • Superior border of the scapula
  • Posterior border of clavicle
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5
Q

What is the lateral border?

A

The intertubercular groove of the humerus

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6
Q

What is the medial border?

A
  • Serratus anterior
  • Thoracic wall
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7
Q

What is the anterior border?

A
  • Pec major
  • Pec minor
  • Subclavius
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8
Q

What is the posterior border?

A
  • Subscapularis
  • Teres major
  • Lat dorsi
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9
Q

How does the size and shape of axilla vary with the degree of the abduction of the shoulder?

A

Apex decreases in size when arm is fully abducted, leading to risk of compression of contents of axilla

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10
Q

What are the contents of the axilla?

A
  • Axillary artery and its branches
  • Axillary vein and its tributaries
  • Brachial plexus
  • Axillary lymph nodes
  • Short head of biceps brachii and coracobrachialis (pass through the axilla after originating at coracoid process)
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11
Q

How many routes are there for structures to move through in the axilla?

A

3

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12
Q

What is the main route of passage in the axilla?

A

Inferolaterally, into the upper limb

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13
Q

What is the next passageway in the axilla?

A

Quadrangular space

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14
Q

What is the third passageway in the axilla?

A

Clavipectoral triangle

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15
Q

What is the quadrangular space?

A

The gap in the posterior wall of the axilla leading to the posterior arm and shoulder. It is made up of up:

  • Teres minor
  • Teres major
  • Long head of biceps brachii

Nerves: axillary nerve

Artery: circumflex humeral artery

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16
Q

What is the clavipectoral triangle?

A

Opening in the anterior wall of axilla. Bounded by

  • pec major
  • deltoid
  • clavicle

Special structures: medial and lateral pectoral nerves (leave the triangle)

-Cephalic nerve enters the triangle (along deltoid)

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17
Q

What is thoracic outlet syndrome? What are the common causes? What is the presentation

A

Compression of vessels and nerves between bones at the apex of the axilla.

  • trauma
  • repetitive movements
  • cervical rib (from 7th vertebrae)

Presentation: tingling, muscle weakness and discolouration

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18
Q

What is the relevance of lymph node biopsy?

A
  • 75% of lymph from the breast drains into axilla lymph nodes so can be biopsied for breast cancer
  • remove axillary lymph nodes of cancer in detected (axillary clearance) - but can damage long thoracic nerve leading to winged scapula (paralysis of serratus anterior)
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19
Q

What are the anterior axillary folds, what are the posterior axillary folds? What is the midaxillary line?

A
  • Anterior axillary fold = formed by lateral border of lat dorsi
  • Posterior axillary fold = formed by lat dorsi and teres major
  • Mid-axillary line = between the anterior and posterior axillary folds
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20
Q

What is the cubital fossa? What does it look like?

A

The transition from the arm to the forearm

-depression on the anterior surface of elbow joint

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21
Q

How many borders are there in the cubital fossa?

A

5

  • Lateral
  • Medial
  • Superior
  • Floor
  • Roof
22
Q

What is the lateral border of the cubital fossa?

A

Medial border of brachioradialis

23
Q

What is the medial border of the cubital fossa?

A

Lateral border of pronator teres

24
Q

What is the superior border of the cubital fossa?

A

A line between the two epicondyles of the humerus

25
Q

What is the floor of the cubital fossa?

A

Brachialis and supinator

26
Q

What is the roof of the cubital fossa?

A
  • Skin
  • Fascia
  • Bicipital aponeurosis (aponeurosis of biceps tendon)
27
Q

Where is the medial cubital vein within the cubital fossa?

A

Roof

28
Q

What are the contents in the cubital fossa (lateral to medial)?

What is the mnemonic for it?

A
  • Radial nerve (under brachioradialis, dividing into deep and superficial branches)
  • Biceps tendon (runs through fossa and attaches to radial tuberosity)
  • Brachial artery (bifurcates into radial and ulnar arteries)
  • Median nerve (between the two heads of the pronator teres)

(also have radial and ulnar veins)

REALLY NEED BEER TO BE AT MY NICEST

29
Q

How do you measure blood pressure?

A

Brachial artery –> brachial pulse. Medial to the biceps tendon

30
Q

What is venepuncture?

A

Taking blood from median cubital vein (joining of basilic and cephalic vein)

31
Q

What is a supracondylar fracture?

What can the damage cause?

What condition can it cause?

A
  • Fracture to humerus
  • Transverse fracture spanning both epicondyles
  • May damage contents of cubital fossa
  • The damage and swelling can interfere blood flow of the brachial artery
  • It can cause Volkmann’s ischaemic contracture
32
Q

What is Volksmann’s ischaemic contracture?

A
  • Uncontrolled flexion of hand as flexor muscles become fibrotic and short
  • Damage to median and radial nerve
33
Q

What is the carpal tunnel?

What does it serve as?

A

The narrow passageway on the anterior part of the wrist.

It serves as an entrance to the palm for 9 tendons and the median nerve

34
Q

What are the two layers of the carpal tunnel?

A

1) deep carpal arch
2) superficial flexor retinaculum

35
Q

What is the deep carpal arch?

A
  • It is concave and forms the base and sides of the carpal tunnel.
  • Formed laterally by scaphoid and trapezium
  • Formed medially by hook of hamate and pisiform
36
Q

What is the superficial flexor retinaculum?

A

Thick connective tissue that forms the roof of the carpal tunnel

-Spans hook of hamate and pisiform to scaphoid and trapeziun

37
Q

What are the 9 tendons in the carpal tunnel?

A
  • Flexor pollicus longus
  • Flexor digitorum profundus (x4)
  • Flexor digitorum superficialis (x4)
38
Q

What are the sheaths surrounding the tendons in carpal tunnel?

A

The 8 tendons are surrounded by a single synovial sheath

-Flexor pollicus longus has its own synovial sheath which allows free movement of the tendon

39
Q

Tell me about the median nerve in the carpal tunnel

A
  • Palmar cutaneous branch of the median nerve branches before the nerve enters carpal tunnel (so travels superficially). This nerve supplies central palm (sensory)
  • After median nerve enters carpal tunnel, it gives rise to recurrent branches and palmar digital branches of the median nerve
40
Q

What does the palmar digital branch of the median nerve supply?

A
  • Sensory innervation to palmar skin (laterla 3.5 digits)
  • sensory innervation to dorsal nail of lateral 3.5 digits
41
Q

What do the recurrent branches of the median nerve supply?

A

Supplies the thenar muscles

42
Q

What is carpal tunnel syndrome?

What is it caused by?

What does it cause on the thenar muscles?

What are the clinical features?

A
  • Compression of median nerve within carpal tunnel
  • mononeuropathy caused by thickened ligaments and tendon sheaths
  • can cause weakness and atrophy of thenar muscles
  • Clinical features: numbness, tingling, pain.

Worse in the mornings

43
Q

How to test for carpal tunnel syndrome?

A
  • Tinel’s sign (tapping the nap in the carpal tunnel to elicit pain)
  • Phalen’s manoeuvre (holding the wrist in flexion for 30 seconds to elicit numbness/pain)
44
Q

How do you treat carpal tunnel syndrome?

A
  • Splint
  • Corticosteroids to reduce swelling of connective tissue
  • Surgical decompression in severe cases
45
Q

What is the anatomical snuffbox (radial fossa)?

Where is it?

A

Triangular depression on the lateral aspect of the dorsum of the hand.

It is on the same level as the carpal bones

46
Q

What are the borders of the anatomical snuffbox?

A

Ulnar = extensor pollicus longus

Radial = extensor pollicus brevis and abductor longus tendons

Proximal = radial styloid process

Floor = scaphoid and trapezium

Roof = skin

47
Q

What muscle makes up the ulnar border of the anatomical snuffbox?

A

Extensor pollicus longus

48
Q

What is the radial border of the anatomical snuffbox?

A

Extensor pollicus brevis

Abductor pollicus longus (closer to the thumb than extensor pollicus brevis)

49
Q

What are the 3 contents of the anatomical snuffbox?

A
  • Radial artery = travels between the heads of the adductor pollicus muscle
  • Superficial branch of radial nerve = found in skin and subcutaneous tissue of anatomical snuffbox. innervates dorsal surface of 3.5 digits and the associated area on the back of the hand
  • Cephalic vein = arises from dorsal venous network
50
Q

What is a scaphoid fracture?

What is it caused by?

What are the clinical features?

A
  • Fracture of scaphoid bone (most commonly fractured carpal bone)
  • Normally caused by falling on an outstretched hand
  • Clinical features = pain and tenderness of anatomical snuffbox
51
Q

Why is the scaphoid at risk of avascular necrosis after fracture?

A
  • It has a retrograde blood supply which means the blood flow enters from the distal end to the proximal end
  • Hence, fracture to the middle/waist of this bone can interrupt blood flow to the proximal part of the scaphoid, rendering it avascular
52
Q

What are the ligaments surrounding humerus and scapula?

A
  • Coracoacromial liagment
  • Coracohumeral ligament
  • Glenohumeral ligament
  • Transverse humeral ligament

Upper limb (2 decks)

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