Upper Limb Flashcards

(101 cards)

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
Fracture of the styloid process of radius
Chauffeur’s fracture
26
Madelung deformity
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
27
Monteggia fracture dislocations
Fracture of upper third of shaft of ulna with dislocation of radial head at superior ulnar joint
28
The fracture of the lower third of shaft of radius associated with dislocation of inferior radio-ulnar joint
Galeazzi fracture dislocation
29
The knowledge of ossification of carpal bones is important in determining what
Bone age of child
30
Bennet’s fracture
Oblique fracture at the base of first metacarpal
31
Boxer’s fracture
Neck of metacarpal Most commonly of the 5th metacarpal
32
Articulations of the shoulder joint complex
1. Glenohumeral joint (shoulder joint) 2.Acromioclavicular joint 3. Sternoclavicular 4. Scapulothoracic
33
Shoulder joint (glenohumeral joint )
TYPE - ball and socket type of synovial joint ARTICULAR SURFACES - LIGAMENTS BURSAE RELATED TO RELATIONS ARTERIAL SUPPLY NERVE SUPPLY MOVEMENTS FACRORS PROVIDING STABILITY CLINICAL
34
Movements permitted by shoulder joint (4 groups of movements ) and in which plane
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
35
Nerve supply of the shoulder joint
Axillary nerve Suprascapular nerve Musculocutaneous nerve
36
Arterial supply of the shoulder joint is by
1. Anterior posterior circumflex humeral arteries 2. Suprascapular artery 3. Subscapular artery
37
Factors providing stability to the shoulder joint
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 )
38
Relations of the shoulder joint
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
39
Articulate surfaces of the shoulder joint
Large round head of humerus w/ relatively shallow glenoid cavity of scapula . Cavity is deepened slightly but effectively by fibrocartilaginous ring glenoid labrum.
40
Ligaments of the shoulder joint
1. Capsular ligament 2. Glenohumeral ligaments 3. Coracoacromial 4. Transverse humeral ligament
41
Fascial spaces of hand or surgical spaces if the hand
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
What are the various spaces of the hand
Palmar : mid palmar Thenar space Pulp spaces of digits Dorsal: Dorsal subcutaneous space Dorsal subaponeurotic space Space of parona
43
Mid palmar spaces and infection
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
Clinical Correlation of the midplamar space
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
Clinical correlation of thenar space
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
Axillary nerve provides motor innervation to & sensory innervation to
the deltoid and teres minor Shoulder joint and skin over the lateral part of the shoulder
47
Main root values of axillary nerve
C5 C6
48
Musculocutaneous nerve motor innervation to Sensory innervation ton
*Muscles in front of the arm Coracobrachialis (axilla ) In arm - biceps brachii Brachalis *lateral part of forearm skin
49
The largest nerve of brachial plexus
Radial nerve
50
Muscles innervated by C5
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
Insertion of the supraspinatus and infraspinatus muscle and the teres minor
Greater tubercle
52
Insertion of the subscapularis
Lesser tubercle of the humerus
53
Origin of teres minor
Lateral border of the scapula
54
Ligaments of the shoulder joint
*Coracohumeral ligament *Superior glenohumeral ligament *middle glenohumeral ligament *inferior glenohumeral ligament *coracoacromial ligament
55
Muscles associated with the shoulder joints
Supraspinatus Infraspinatus Teres minor Subscapularis Teres major Long head of the triceps brachii Long head of the biceps brachii
56
My
57
Boundaries of the axilla
1. Apex / cervico- axillary canal 2. Base /floor 3. Anterior wall 4. Posterior wall 5. Medial wall 6.lateral wall
58
Anterior wall of the axils is made up of
Pectoralis major Pectoralis minor Subclavius
59
Posterior wall of axilla is made by the
Subscapularis muscle above Latissmus dorsi Teres major muscles below
60
Medial wall and lateral wall of the axilla is formed by
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
Contents of the axilla
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 7. Long thoracic and intercostobrachial nerves
62
Erb’s point
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
Erb’s paralysis What Causes
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
Klumpke’s paralysis
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
The different levels of axillary lymph nodes
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
Arterial anastomosis around scapula
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
Quadrangular space in the scapular region Structures passing through
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
Upper triangular space
Superior :teres minor Lateral : long head of triceps Inferior : teres major Passing through: circumflex scapular artery
69
Lower triangular space
Medial : long head of triceps Lateral : shaft of humerus Superior : teres major Structures Radial nerve Profunda brachii artery and vein
70
Structures through extensor retinaculum 1st compartment
APL EPB
71
Structures through extensor retinaculum 2nd compartment
ECRL ECRB
72
Structures through extensor retinaculum III compartment
EPL
73
Structures through extensor retinaculum IV compartment
ED EI PIN AIA
74
Structures through extensor retinaculum VI compartment
ECU
75
Structures through extensor retinaculum V compartment
EDM
76
Muscles in the hand innervated by the median nerve
1/2 lumbricals (lateral 2) Opponens Pollicis Abductor pollicis brevis 1/2 flexor pollicis brevis [Thenar muscles]
77
Claw hand is due to the injury of
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
Sign of benediction is due to
Median nerve injury
79
The muscles in the hand supplied by the ulnar nerve
1/2 of flexor digitorum profundus 3rd and 4th lumbricals Interosseous muscles Adductor pollicis
80
Arterial supply of the breast
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
Venous drainage of breast
82
Lymphatic nodes and lymphatics
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
Lymphatic drainage from breast
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
Deep lymphatics of the breast
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
Radical mastectomy
whole of breast is removed along with axillary lymph nodes pectoralis major and minor muscles.
86
Krukenberg’s tumor.
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
Breast cancer or carcinoma of the breast
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
Winging of the scapula
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
Clinical correlation of the cubical fossa
* 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
Contents of cubital fossa
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
Boundaries of the cubital fossa
92
Superficial fascia of cubical fossa contains
*Median cubital vein connecting cephalic and basilic veins *medial and lateral cutaneous nerves of the forearm
93
Pronation
*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
Supination
More powerful than pronation , antigravity *more powerful muscles
95
Clinical anatomy for supination and pronation
In synostosis (fusion ) - upper end of radius and ulna fused . Pronation not possible
96
The nerve called the labourer’s nerve
Median nerve Course movements by flexor muscles of the forearm
97
The nerve termed as eye of the hand , reason
Median nerve Sensory innervation to the pulp of the thumb and index finger , used for performing fine movements
98
Number of tendons in the carpal tunnel and it’s other contents
Median nerve 9 flexor tendons of fingers and thumb Synovial sheath
99
no sensory loss over the thenar eminence in carpal tunnel syndrome
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
Positive tests for carpal tunnel
Tinel’s sign Phalen’s test
101
Compression of median nerve pathological conditions such as How to relieve it
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.