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Anatomy > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

Muscles that attach to the clavicle

A

Pectoralis major
Sternocleidomastoid
Deltoid
Trapezius
Subclavius

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2
Q

Two parts of the coracoclavicular ligament of the clavicle

A

Trapezoid part
Conoid part

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3
Q

Muscles attached to scapula

A

Subscapularis
Serratus anterior
Triceps (long head )
Omohyoid
Pectoralis minor
Biceps brachii
Coracobrachialis
Latissmus Dorsi
Teres major
Teres minor
Deltoid
Trapezius
Levator scapulae
Supraspinatous
Rhomboideus minor
R.major

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4
Q

The muscle that attaches close to the inferior angel of scapula

A

Latissmus dorsi

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5
Q

Insertion of muscles on the humerus

A

Deltoid
Coracobrachialis
Teres major
Teres minor
Pectoralis major
Latissmus dorsi
Subscapularis
Supraspinatus
Infraspinatus

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6
Q

Origins of muscles at the humerus

A

Brachialis
Brachioradialis
ECRL
Pronator Teres
Common flexor origin
Common extensor origin
Lateral head of triceps
Medial head of triceps
Anconeus

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7
Q

What does it mean , the upper limb is light build

A

Bones are smaller , weaker , joints are smaller and less stable, .
More prone to injuries like dislocation and fractures

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8
Q

Common dislocations in the upper limb are

A

Dislocation of the shoulder joint (most common )
Elbow joint
Lunate bone

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9
Q

Most common fractures of the upper limb

A

Clavicle (most common in the body )
Humerus
Radius
Scaphoid (most common in hand )

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10
Q

Common nerve injuries in upper limb

A

Brachial plexus
Median nerve (most common peripheral neuropathy- compression at wrist )
Radial nerve
Ulnar nerve

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11
Q

Major nerves of upper limb that have predilection of involvement in leprosy

A

Radial
Median
Ulnar (palpated at medial epicondyle)

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12
Q

Intravenous injection commonly given at

A

Superficial veins in front of elbow and dorsum of hand

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13
Q

Intramuscular injection is most commonly given

A

Shoulder region in deltoid muscle

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14
Q

Part of the upper limb having largest representation in the brain

A

Hand

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15
Q

Where does the clavicle fracture commonly

A

Junction of its lateral one-third , medial two third (weakest site , two curvatures meet , transmission of forces to scapula occurs at this site through coracoclavicular ligament
Trapezius alone is unable to support the weight of the upper limb.
Medial fragment elevated by sternicleidomastoid

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16
Q

A patient supporting his sagging upper limb with the opposite hand is the clinical picture of the patient

A

Clavicle fracture

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17
Q

Clavicular dysostosis

A

Clinical condition , medial and lateral parts of clavicle remain separate due to non union of two primary centres of ossification

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18
Q

Cleidocranial dysostosis

A

Partial or complete absence of clavicle . Associated with defective ossification of bones

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19
Q

Sprengel’s deformity of the scapula

A

Congenital high scapula . The scapula develops in the neck region during IUL and then migrated downwards to its adult position .
Failure to descend , i this condition scapula I’d hypoplastic and in the neck region .
Omovertebral body connecting it to cervical part of vertebral column by fibrous , cartilaginous or bony
Surgery to bring down injures brachial plexus

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20
Q

Nerves directly related to the humerus

A

Axillary - surgical neck
Radial - radial groove
ulnar - behind medial epicondyle

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21
Q

Common sites of fractures of humerus

A

Surgical neck
Shaft
Supracondylar region - involves median nerve and brachial artery

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22
Q

Fracture to which bone can cause volkmann’s ischemic contracture and myosotis ossificans

A

Supracondylar fracture of the humerus
Volkmann’s - median and ulnar nerve

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23
Q

Weight bearing bone of the forearm

A

Radius (hence features are common )

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24
Q

Colles’ fracture

A

Fracture at the distal end of RADIUS distal fragment is displaced backwards and upwards .
Reverse of Colles’ = smith’s fracture

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25
Q

Fracture of the styloid process of radius

A

Chauffeur’s fracture

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26
Q

Madelung deformity

A

Congenital anomaly of radius with clinical features
*anterior bowing of distal end of radius , abnormal growth of distal epiphysis .
Occurs between 10 to 14 years - premature disappearance of distal epiphyseal line
Subluxation or dislocation of distal end of ulna

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27
Q

Monteggia fracture dislocations

A

Fracture of upper third of shaft of ulna with dislocation of radial head at superior ulnar joint

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28
Q

The fracture of the lower third of shaft of radius associated with dislocation of inferior radio-ulnar joint

A

Galeazzi fracture dislocation

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29
Q

The knowledge of ossification of carpal bones is important in determining what

A

Bone age of child

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30
Q

Bennet’s fracture

A

Oblique fracture at the base of first metacarpal

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31
Q

Boxer’s fracture

A

Neck of metacarpal
Most commonly of the 5th metacarpal

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32
Q

Articulations of the shoulder joint complex

A
  1. Glenohumeral joint (shoulder joint)
    2.Acromioclavicular joint
  2. Sternoclavicular
  3. Scapulothoracic
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33
Q

Shoulder joint (glenohumeral joint )

A

TYPE - ball and socket type of synovial joint
ARTICULAR SURFACES -
LIGAMENTS
BURSAE RELATED TO
RELATIONS
ARTERIAL SUPPLY
NERVE SUPPLY
MOVEMENTS
FACRORS PROVIDING STABILITY
CLINICAL

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34
Q

Movements permitted by shoulder joint (4 groups of movements ) and in which plane

A
  1. Flexion and extension -Sagittal plane around the frontal axis
  2. Abduction and adduction - from frontal plane around sagittal axis
  3. Medial and lateral rotation -transverse plane vertical axis
  4. Circumduction

Move in all 3 planes and 3 axis

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35
Q

Nerve supply of the shoulder joint

A

Axillary nerve
Suprascapular nerve
Musculocutaneous nerve

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36
Q

Arterial supply of the shoulder joint is by

A
  1. Anterior posterior circumflex humeral arteries
  2. Suprascapular artery
  3. Subscapular artery
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37
Q

Factors providing stability to the shoulder joint

A
  1. Rotator cuff (musculotendinous cuff)
  2. Coracoacromial arch ( prevents upward dislocation of the head of the humerus )
  3. Long head of biceps tendon (passes above the head of humerus intracapsular )
    4.glenoid labrum
    (Deepens the shallow cavity )
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38
Q

Relations of the shoulder joint

A

Superiority : coracoacromial arch , subacromial bursa
Supraspinatous
, delotoid
Inferiorly :Arterial supply/ posterior circumflex humeral vessels
long head of triceps
Axillary nerve
Anteriorly : subscapularis
Subscapular bursa
Corachobravhiakis
Short head of biceps brachii. Deltoid
Posteriorly ; infraspinatous
Deltoid , Teres minor

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39
Q

Articulate surfaces of the shoulder joint

A

Large round head of humerus w/ relatively shallow glenoid cavity of scapula .
Cavity is deepened slightly but effectively by fibrocartilaginous ring glenoid labrum.

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40
Q

Ligaments of the shoulder joint

A
  1. Capsular ligament
  2. Glenohumeral ligaments
  3. Coracoacromial
  4. Transverse humeral ligament
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41
Q

Fascial spaces of hand or surgical spaces if the hand

A

Normally potential spaces , filled with loose connective tissue , become obvious when fluid or pus collects .
Great surgical importance, get infected and distended with pus , limit spread of infection

42
Q

What are the various spaces of the hand

A

Palmar : mid palmar
Thenar space
Pulp spaces of digits

Dorsal:
Dorsal subcutaneous space
Dorsal subaponeurotic space

Space of parona

43
Q

Mid palmar spaces and infection

A

Triangular , located under the medial half of hollow of the palm .
Boundaries :
anteriorly - 1. Palmar aponeurosis (superficial )
2.superficial palmar arch
3.Digital nerve and vessels,cupplying medial 3 1/2fimgers
4.ulnar bursa enclosing flexor tendons of medial three fingers

44
Q

Clinical Correlation of the midplamar space

A

Infection of the mid pals at space
ulnar bursa
-considered as the inlet for infection and lumbrical canals as the outlets of infection
Pus form in this space , drained by incisions(in medial two web spaces )

45
Q

Clinical correlation of thenar space

A

Infection may reach from infected radial bursa or
synovial sheath of index finger
Pus from the air space drained by incision (first web space ,of thumb)

46
Q

Axillary nerve provides motor innervation to
& sensory innervation to

A

the deltoid and teres minor
Shoulder joint and skin over the lateral part of the shoulder

47
Q

Main root values of axillary nerve

A

C5 C6

48
Q

Musculocutaneous nerve motor innervation to
Sensory innervation ton

A

*Muscles in front of the arm
Coracobrachialis (axilla )
In arm - biceps brachii
Brachalis
*lateral part of forearm skin

49
Q

The largest nerve of brachial plexus

A

Radial nerve

50
Q

Muscles innervated by C5

A

Supraspinatus
Infraspinatus
Teres minor
Deltoid
Rhomboideus major and minor
Coracobrachialis,
biceps brachii and brachialis
Brachioradialis
Supinator
( abductors and lateral rotators of the shoulder)
Flexors and supinators if the forearm

51
Q

Insertion of the supraspinatus and infraspinatus muscle and the teres minor

A

Greater tubercle

52
Q

Insertion of the subscapularis

A

Lesser tubercle of the humerus

53
Q

Origin of teres minor

A

Lateral border of the scapula

54
Q

Ligaments of the shoulder joint

A

*Coracohumeral ligament
*Superior glenohumeral ligament
*middle glenohumeral ligament
*inferior glenohumeral ligament
*coracoacromial ligament

55
Q

Muscles associated with the shoulder joints

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Teres major
Long head of the triceps brachii
Long head of the biceps brachii

56
Q

My

A
57
Q

Boundaries of the axilla

A
  1. Apex / cervico- axillary canal
  2. Base /floor
  3. Anterior wall
  4. Posterior wall
  5. Medial wall
    6.lateral wall
58
Q

Anterior wall of the axils is made up of

A

Pectoralis major
Pectoralis minor
Subclavius

59
Q

Posterior wall of axilla is made by the

A

Subscapularis muscle above
Latissmus dorsi
Teres major muscles below

60
Q

Medial wall and lateral wall of the axilla is formed by

A

Medial : upper four or five ribs
Corresponding intercostal spaces
Covered by serratus anterior muscle

Lateral: tendon of biceps brachii in bicipital groove of humerus
Coracobrachialis
Short head of biceps brachii

61
Q

Contents of the axilla

A
  1. Axillary artery and it’s branches
  2. Axillary vein and it’s tributaries
  3. Cords of the brachial plexus
  4. Axillary lymph nodes
    5.axillary tail of breast
    6.fibrofatty tissue
  5. Long thoracic and intercostobrachial nerves
62
Q

Erb’s point

A

region of upper trunk of brachial plexus where six nerves meet as follows: 5th and 6th cervical roots join to form the upper trunk, which gives off two nerves—suprascapular and nerve to subclavius, and then divides into anterior and posterior divisions.

63
Q

Erb’s paralysis
What
Causes

A

Injury to upper brachial plexus (C5 , C6 )
Lead to : excessive increase in angle between the head and shoulder

Policeman tip position
( arm hangs by side , adducted =deltoid muscle paralysis
and medially rotated = supraspinatus , infraspinatus , teres minor , forearm extended =paralysis of biceps brachii
and pronated forearm = paralysis of biceps brachii )
Causes :fall from height land on shoulder
Traction of the arm during childbirth and hyper extension of the neck

64
Q

Klumpke’s paralysis

A

Lower trunk of plexus injury (C8 , T1)
Increase I. Angle between trunk and shoulder
Causes : hyper abduction of arm
Falls on outstretched hand
Arm pulled into machinery or during delivery
Clinical features : claw hand , due to paralysis of flexors of wrist and fingers
All intrinsic muscles of hand
Loss of sensation along medial border of forearm and hand
Hornets syndrome

65
Q

The different levels of axillary lymph nodes

A

Level I nodes : lie lateral to the lower border of pectoralis minor muscle
Level II :they lie deep to the pectoralis minor muscle
Level III : medial to the upper border of pectoralis minor muscle

66
Q

Arterial anastomosis around scapula

A

Between branches of first part of subclavian & third part of axillary arteries .
At 2 sites
1. Around the body of the scapula - occurs between the suprascapular artery ( thyrocervical trunk =1st part of subclavian)
Circumflex scapular artery (subscapular = branch of 3rd part of axillary)
Deep branch of transverse cervical artery ( thyrocervical )
2. Over the acromion process
(a) acyromialbranch ofthe thoraco-acromialartery,
(b) acromial branch of the suprascapular artery, and
(c) acromial branch of the posterior circumflex humeral
artery.

67
Q

Quadrangular space in the scapular region
Structures passing through

A

Axillary nerve
Posteriors circumflex humeral artery and vein

Superior : teres minor(post)
Subscapularis(ant)
Capsule of shoulder joint between the above two muscles

Inferior : teres major
Medial : long head of triceps
Lateral : surgical neck of the humerus

68
Q

Upper triangular space

A

Superior :teres minor
Lateral : long head of triceps
Inferior : teres major

Passing through: circumflex scapular artery

69
Q

Lower triangular space

A

Medial : long head of triceps
Lateral : shaft of humerus
Superior : teres major

Structures
Radial nerve
Profunda brachii artery and vein

70
Q

Structures through extensor retinaculum
1st compartment

A

APL
EPB

71
Q

Structures through extensor retinaculum
2nd compartment

A

ECRL
ECRB

72
Q

Structures through extensor retinaculum
III compartment

A

EPL

73
Q

Structures through extensor retinaculum
IV compartment

A

ED
EI
PIN
AIA

74
Q

Structures through extensor retinaculum
VI compartment

A

ECU

75
Q

Structures through extensor retinaculum
V compartment

A

EDM

76
Q

Muscles in the hand innervated by the median nerve

A

1/2 lumbricals (lateral 2)
Opponens Pollicis
Abductor pollicis brevis
1/2 flexor pollicis brevis
[Thenar muscles]

77
Q

Claw hand is due to the injury of

A

Ulnar nerve ( lumbricals and interossei of the 5th and 4th phalanges )
Extensor digitorum is unopposed = hyper extension of at MCPjoints
Hyper flexion at IP joints

78
Q

Sign of benediction is due to

A

Median nerve injury

79
Q

The muscles in the hand supplied by the ulnar nerve

A

1/2 of flexor digitorum profundus
3rd and 4th lumbricals
Interosseous muscles
Adductor pollicis

80
Q

Arterial supply of the breast

A

Highly vascular
1. Internal thoracic artery ( mammary) - through its perforating branches , which pierce the 2nd , 3rd , 4th intercostal spaces
2. Axillary artery - thro it’s lateral thoracic ,superior thoracic , acromio thoracic branches
3. PIC arteries thro lateral branches

81
Q

Venous drainage of breast

A
82
Q

Lymphatic nodes and lymphatics

A

Lymph nodes that drain ‘ :
1.axillary lymph nodes (75%) - [ anterior/pectoral —- posterior — central and lateral ]most into anterior , rest into posterior and apical .
Anterior & post first into central and lateral and then supraclavicular
2.internal mammary lymph nodes (20%)
3.supraclavicular nodes
4.posterior intercostal nodes (5%)
5. Cephalic/ deltopectoral nodes
In addition , also drains into subdiaphragmatic and subperitoneal lymph plexuses

Diagram
Lymphatics draining the breast
1. Superficial= drain the skin of the breast except nipple and Areola
2.Deep = drain parenchyma of breast , nipple , Areola

83
Q

Lymphatic drainage from breast

A
  1. From lateral quadrants Into anterior axillary/ pectoral group
    Situated deep to the lower border of pectoralis minor
  2. From medial quadrants
    Into internal mammary of same or opposite side ( along internal mmary artery )
  3. Few of LL - follow posterior intercostal arteries into PIC nodes
  4. Few LM - pierce the anterior abdominal wall- subdiaphragmatic, subperitoneal lymph plexuses
    5.nodes from deep surface pierce p.major and clavipectoral fascia - drain into apical group of axillary m lymph nodes
84
Q

Deep lymphatics of the breast

A

Drain the parenchyma of the breast , skin of nipple and areola

A plexus of lymph vessels deep to the areola = subareolar plexus of sappey
Subareolar plexus and most of the lymph from the breast drain into the anterior group of axis,are lymph nodes .

Superficial lymphatics of the one side interact with that of the opposite . Unilateral malignancy may become bilateral

85
Q

Radical mastectomy

A

whole of breast is removed along with axillary lymph nodes
pectoralis major and minor muscles.

86
Q

Krukenberg’s tumor.

A

lymph vessels from the inferomedial quadrant of
the breast communicate with the subperitoneal lymph plexus and carry cancer cells to it. From here cancer cells migrate transcoelomically and deposit on the ovary producing a secondary tumor in ovary

87
Q

Breast cancer or carcinoma of the breast

A

arises from the epithelial cells of the lactiferous ducts. In about 60% cases, itupper lateral quadrant and commonly affects females between 40–60 years of age

(a) Presence of a painless hard lump.
(b) Breast becomes fixed and immobile, due to infiltration
of suspensory ligaments.
(c) Retraction of skin, due to infiltration of suspensory
ligaments.
(d) Retraction of nipple due to infiltration and fibrosis of
lactiferous ducts.
(e) peau d’orange’ appearance of the skin (i.e., skin giving
rise to appearance like that of the skin of the orange)
due to obstruction of superficial lymphatics.
• The knowledge of lymphatic drainage of the breast is of great clinical importance due to high percentage of occurrence of cancer in the breast and its subsequent dissemination of cancer cells (metastasis) along the
lymph vessels to the regional lymph nodes.

88
Q

Winging of the scapula

A

Paralysis of serratus anterior -
Protraction of scapula weakened
Inferior angle and medial border - unduly prominent
Injury to long thoracic nerve ( stab injury or during removal of breast tumor )

89
Q

Clinical correlation of the cubical fossa

A
  • MEDIAL CUBITAL VEIN
    collect blood , intravenous injections
    *Brachial pulse is commonly felt , medial to tendon of biceps . Pulsations auscultated for recording blood pressure.
    Elbow flexed - easily palpable
    *to deal with elbow fractures - supracondylar fracture
90
Q

Contents of cubital fossa

A

Medial to lateral
Median nerve : leaves fossa passing b/w 2 heads of pronation teres
Brachial artery :terminates here at neck of radius - into radial (superficial, leaves fossa at the apex )and ulnar arteries (deep , passes deep to pronator teres )
Biceps tendon : passes backwards and a,Tera.Lu to be attached to radial tuberosity
Radial Nerve : lies in gap b/w brachial is medically and brachioradialis lateral epicondyle two branches :
Superficial - downwards under cover of brachioradialis
Deep - disappears in substance of supination muscle

91
Q

Boundaries of the cubital fossa

A
92
Q

Superficial fascia of cubical fossa contains

A

*Median cubital vein connecting cephalic and basilic veins
*medial and lateral cutaneous nerves of the forearm

93
Q

Pronation

A

*Head of radius spins within the annular ligament
* lower end of radius crosses in front of the lower end of ulna
* interosseous membrane gets spiralised
*muscles - pronator quadratus mainly
Aided by p.teres
* gravity also helps

94
Q

Supination

A

More powerful than pronation , antigravity
*more powerful muscles

95
Q

Clinical anatomy for supination and pronation

A

In synostosis (fusion ) - upper end of radius and ulna fused .
Pronation not possible

96
Q

The nerve called the labourer’s nerve

A

Median nerve
Course movements by flexor muscles of the forearm

97
Q

The nerve termed as eye of the hand , reason

A

Median nerve
Sensory innervation to the pulp of the thumb and index finger , used for performing fine movements

98
Q

Number of tendons in the carpal tunnel and it’s other contents

A

Median nerve
9 flexor tendons of fingers and thumb
Synovial sheath

99
Q

no sensory loss over the thenar eminence in carpal tunnel syndrome

A

skin over thenar eminence is supplied by the palmar cutaneous branch of the median nerve, which passes superficial to flexor retinaculum.
But weakness of thenar muscles

100
Q

Positive tests for carpal tunnel

A

Tinel’s sign
Phalen’s test

101
Q

Compression of median nerve pathological conditions such as

How to relieve it

A

a)tenosynovitis of flexor tendons (idiopathic),
(b) myxedema (deficiency of thyroxine),
(c) retention of fluid in pregnancy,
(d) fracture dislocation of lunate bone, and
(e) osteoarthritis of the wrist

decompressing the tunnel by giving a longitudinal incision through flexor retinaculum.

Anatomy (6 decks)

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