Upper Limb Flashcards
Name the borders of the axilla
Apex (axillary inlet) - lateral border 1st rib, superior border scapula, posterior border clavicle
Lateral wall - intertubercular groove humerus
Medial wall - serratus anterior and thoracic wall
Anterior wall - pectoralis major, minor, subclavius
Posterior wall - subscapularis, teres major, latissimus dorsi
Name the contents of the axillary artery
Axillary artery and branches Axillary vein and branches Brachial plexus and branches Axillary lymph nodes Biceps brachi (short head), coracobrachialis
The quadrangular space is a gap in the posterior wall of the axilla.
Which structures pass through the quadrangular space?
Axillary nerve
Posterior circumflex humeral artery
What are the borders of the clavicopectoral triangle?
Clavicle, pectoralis major and deltoid muscle
Which structures pass through the clavicopectoral triangle?
Cephalic vein
Medial and lateral pectoral nerves
Name the borders of the cubital fossa
Superior - line drawn between the humeral epicondyles
Lateral - brachioradialis (medial border)
Medial - pronator teres (lateral border)
Roof - bicipital aponeurosis, fascia, subcutaneous fat and skin
Floor - brachialis (proximally) supinator (distally)
List the contents of the axillary triangle from lateral to medial
Radial nerve - divides into superficial and deep
Biceps tendon - attached onto radial tuberosity
Brachial artery - bifurcates into radial and ulna artery at the apex
Median nerve
Roof contains median cubital vein which connects basilic and cephalic vein
The ulna tunnel is a fibro-osseous space located in the poster-medial aspect of the elbow
- Name it’s border
- Contents
1.1.
Medial - Medial epicondyle
Lateral - olecranon
Floor - joint capsule, medial collateral ligament
Roof - arcuate ligament of Osborne or cubital tunnel retinaculum (medial epicondyle to olecranon)
1.2. Ulna nerve
Define cubital tunnel syndrome and it’s clinical features
Cubital tunnel syndrome refers to the compression of the ulna nerve with the cubital tunnel.
Clinical features:
Pain
Paraesthesia - medial 1 and a half fingers
Weakness and wasting of intrinsic hand muscles
What are the borders which make up the carpal tunnel?
The deep carpal arch
Medially - hook of hamate and pisiform
Laterally - scaphoid and trapezium
Flexor retinaculum - roof
List the contents of the carpal tunnel
FDS
FDP
FPL
Median nerve - palmer cutaneous branch given off pior to carpal tunnel
Name the terminal divisions of the Median nerve
Palmer digital nerve -
Sensory - palmer skin and dorsal nail beds of lateral 3 and a half digits
Recurrent branch - supplies thenar muscle group
Name the borders of the anatomical snuffbox
Medial (ulna) border - Extensor Pollicis Longus
Lateral (radial) border - Abductor Pollicis Longus, Extensor Pollicis Brevis
Floor - scaphoid, trapezium
Proximal border - radial styloid process
Roof - skin
Contents of the anatomical snuff box
Radial artery
Superficial branch radial nerve
Cephalic vein
Thoracic outlet syndrome occurs when the contents passing through the the axillary inlet become compressed between the bones.
- List common causes
- Describe the clinical picture
1.1.
Trauma e.g. fractured clavicle
Repetitive movements
Cervical rib
1.2. Pain in affected limb Tingling Muscle weakness Discolouration
Approximately 75% of lymph from the breast drains into the axilla.
- Which nerve is susceptible to injury during an axillary clearance?
- Which muscle is innervated by this nerve?
- Long thoracic nerve
1. 2. Serratus anterior
Which muscles attach onto the greater tuberosity?
Supraspinatus
Infraspinatus
Teres minor
Attach onto the superior, middle and inferior facets respectively
Which muscles attach onto the lesser tuberosity?
Subscapularis
The intertubercular sulcus separates the greater and lesser tuberosity with it’’s edges are known as the medial and lateral lips.
- Which structure runs through this groove?
- Which muscle(s) attaches to the medial and lateral lips
- Tendon of long head of biceps
- “A lady between 2 majors”
Medial lip - teres major, latissimus dorsi
Lateral lip - pectoralis major
Which neurovascular structures are at risk during a fracture of the surgical neck of humerus?
Axillary nerve
Posterior circumflex humeral artery
The radial groove is a shallow depression which runs diagonally on the posterior aspect of the humerus.
Which anatomical structure(s) run in this groove?
Radial nerve
Profunda brachi artery
Supracondylar fractures can result in injury to which anatomical structure(s)?
Brachial artery
Anterior interosseous nerve (branch of Median nerve)
Ulna nerve
Radial nerve
Supracondylar fractures can result in injury to which anatomical structure(s)?
Brachial artery
Anterior interosseous nerve (branch of Median nerve)
Ulna nerve
Radial nerve
How does one test the anterior interosseous nerve?
Which muscle is innervated by AIN?
Ask the patient to make the “OK” sign
Tests weakness in the FPL
The distal end of the radius articulates with which carpal bones to make up the wrist joint?
Scaphoid
Lunate
Radius and ulna are attached by the interosseous membrane
- Describe a Monteggia fracture
- Describe a Galeazzi fracture
- Fracture of the proximal ulna with a proximal radio-ulna joint dislocation
- Fracture of the distal radius with the ulna head dislocation at the distal radio-ulna joint
Describe a Bennett’s fracture
Fracture of the base of the 1st metacarpal - extending into the 1st CMC joint leading to instability or subluxation of the joint - - often requires surgical repair
Name the muscles of the thenar eminance and the nerve which innervates them
Oponens Pollicis
Abductor Pollicis Brevis
Flexor Pollicis Brevis
Median nerve
Name the muscles of the hypothenar eminance and the nerve which innervates them
Opponens Digiti Minimi
Abductor Digiti Minimi
Flexor Digiti Minimi Brevis
Ulna nerve
The lumbricals of the hand originate on the tendon of FDP and insert onto the extensor hood of it’s corresponding finger.
Denervation of the lumbricals are responsible for ulna claw and hand of benediction.
- What are the actions of the lumbricals
- Innervation
1.1. Flexion of the MCPs and extension of the IP joints
1.2.
Lateral 3.5 - Median nerve
Medial 1.5 - Ulna nerve
The interossei muscles originate from the medial and lateral surfaces of the metacarpals and insert into the extensor hood of the proximal phalanx
- Actions of the dorsal and palmer interossei
- Innervation
1.1.
Palmer interossei - adduction
Dorsal interossei - abduction
1.2. Ulnar nerve
Which muscles share a common origin at the lateral epicondyle?
Extensor carpi radialis brevis
Extensor digitorum
Extensor carpi ulnaris
Extensor Digiti Minimi
The extensor compartment of the forearm contains muscles responsible for extension of the wrist and fingers.
- Name muscles of the superficial posterior compartment of the forearm
- Name the muscles of the deep posterior compartment of the forearm
- Innervation
1.1. Superficial group Brachioradialis ECRL and ECRB ED EDM ECU Anconues
1.2. Deep group Supinator Abductor Pollicis Longus EPL and EPB Extensor indicis
1.3. Radial nerve
The deep muscles of the posterior compartment of the forearm are innervated by the posterior interosseous nerve (branch of radial nerve) except for _______ ?
Supinator - innervated by deep branch radial nerve
Ulnar nerve arise from C8-T1
- Describe it’s anatomical course
- 3 branches arising in the forearm
- Name the branch arising in the hand
- Muscles innervated in the forearm
1.1.
Arises from brachial plexus - descends down arm between axillary artery (lateral) and axillary vein (medial)
Proceeds down medial aspect medial to brachial artery
Mid-point forearm - pierces medial fascia to enter posterior compartment arm then passes through cubital tunnel into forearm
Forearm - pierces the 2 head of FCU and gives off 3 branches
Enters hand via Guyons canal - superficial to Flexor retinaculum - medial to ulnar artery
- Muscular branch, palmar and dorsal cutaneous branches
- Superficial branch
- Medial half of FDP, FCU
What is Froment’s sign?
Tests weakness of ulnar nerve - specifically Adductor Pollicis
The Median nerve (C6-T1) is terminal branch of the brachial plexus. Name the branches given off in the…
- Forearm
- Terminal branches in the hand
1.1.
Anterior interosseous nerve
Palmer cutaneous nerve
1.2.
Recurrent branch - innervates thenar muscles
Palmer digital branch - lateral 2 lumbricals, sensation to lateral 3.5 digits and palmer surface and fingertips
