Upper Limb Flashcards
Where do the nerve roots of the brachial plexus originate from?
Anterior rami
C5, C6 C7 C8 T1
The nerves of the brachial plexus leave the anterior rami and pass through the _______
Intervertebral foramina
What muscles does the original nerve roots of the brachial plexus pass through?
Anterior and medial scalene muscle
The lateral cord of the brachial plexus leads to what 3 nerves?
Musculocutaneous
Median
The median nerve is made up of what cords?
Lateral, Medial
The median nerve is made up of what trunks?
Superior, Middle and Inferior
The posterior cord of the brachial plexus becomes __________
Axillary
Radial
What are the five main branches of the brachial plexus?
Axillary
Ulnar
Radial
Median
Musculocutaneous
What roots create the ulnar nerve
C8 T1
What muscles are supplied by the ulnar nerve?
Muscles of the hand
Flexor carpi ulnaris
Flexor digitorum
Medial 2 lumbricals
What nerve of the brachial plexus is the most medial?
Ulnar
What are the root origins of the musculocutaneois nerve?
C5 C6 C7
What muscles does the musculocutaneous nerve innervate?
Biceps Brachii
Coracobrachialis
Brachialis
What are the nerve root origins of the axillary nerve?
C5 C6
Where would a sensory deficit be felt in axillary nerve injury?
Regimental badge area
What muscles are innervated by the axillary nerve?
Deltoid
Teres minor
What are the nerve root origins of the median nerve?
C6 C7 C8 T1
What nuscles are innervated by the median nerve?
Most flexor muscles (not the flexor carpi ulnaris)
Lateral lumbricals
Thenar muscles
Where is sensory innervation of the median nerve?
Lateral palm
1st 2nd 3rd and quarter of 4th finger
What muscles are innervated by the radial nerve?
Triceps brachii
Posterior compartment of the forearm (i.e the extensors muscles)
What nerve roots make up the radial nerve?
C5 C6 C7 C8 T1
What nerve passes along the groove of the posterior aspect of the medial epicondyle?
UInar Nerve
What compartment is impacted in De Quervian’s Tenosynocitis?
1st compartment
What are the miscles of the 1st compartment
Abductor pollicus longus
Extensor pollicus brevis
Waht are the 3 attachments on the humerus greater tuberosity?
Supraspinatus
Infraspinatus
Teres minor
what rotator cuff muscle attaches to the lesser tuberosity of the humerus?
Subscapularis
What muscles attach to the intertubular sulcus of the humerus?
LAttisimus dorsi
Pectoralis major
Teres minor
What clinical sign will be seen on the humeral surgical neck fracture?
Unable to abduct
What nerve is injured in humeral surgical neck fracture?
Axillary
Where does the axillary nerve pass through?
The quadrangular space
What passes through the clavipectoral triangle?
The cephalic vein enters
Medial and lateral pectoral nerves leave
What vessel can be damaged in a supracondular fracture?
Brachial artery
What muscles attaches to the humerus shaft and where does it attach?
Deltoid
To the deltoid tuberosity
What nerve will be damaged in a mid humeral shaft fracture
Radial nerve
What are the clinical signs seen in humeral shaft fracture?
Wrist drop
Sensory loss to posterior 1-3 lateral fingers
What vessel is at risk of damage in a humeral shaft fracture/
The profunda brachii aka the deep brachial artery
What causes Volkman’s ischaemic contracture?
Damage to brachial artery (supracondylar fracutere)
What does Volkmann’s ischaemia contracture look like?
Uncontrolled flexion of the hand
How to test for Volkman’s contracture?
Ok sign - shows weakness of pollicus longus
What is the branch of the median nerve called?
The anterior interosseus nerve
What classification is used to describe supracondular fractures?
Gartland Classification
Where does the triceps brachiii attach?
Ulna bone - at the olecrannon
Where is the radial notch on the ulna?
LAteral surface
What muscle attaches to the ulnar tuberosity?
Brachiallis
What the the fracture pattern of a Monteggia’s fracture?
Fractured proximal shaft of ulna
Proximal radial head dislocation
What the the fracture pattern of a Galaezzi’s fracture?
Fractured distal radius
Dislocation of the ulnar head
What muscle attaches to the anterior shaft of the ulna?
Pronator Quadratus
What forms the roof of the ulnar tunnel?
Arcuate ligament
What movement elicits difficulty in cubital tunnel syndrome?
Elbow flexion
Where would the brachial artery be plapated?
Medial to the biceps tendon
What muscles are contained in the carpal tunnel?
Flexor pollicus longus
4x flexor digitorum profundus
4x flexor digitorum superficialis
List the components of the cubital fossa from lateral to medial?
Radial nerve
Biceps tendon
Brachial artery
Median nerve
What does the medial cubital vein become?
Basilic and cephalic veins
What compartment is the extensor pollicus longus contained in
3rd
What nerve is most at risk in a clavicle fracture?
Supraclavicular
In a clavicular fracture, what direction is the clavicle displaced?
Anterior
What muscle is responsible for displacing clavicle in a fracture
Sternocleidomastoid
Where does the biceps brachii insert?
Radial tuberosity
What muscle inserts into the shaft of the radius?
The pronator teres
Where is teh styloid provess?
Lateral head of distal radius
What fracture causes a “dinner fork” anomaly?
Colles
What is the fracture pattern of a colles fracture?
Posterior displacement of hand and wrist
Fracture of distal radius
What is the fracture pattern of a Smith’s fracture?
Anterior displacement of wrist
Radial fracture
What bone is injured in a boxes fracture?
5th metacarpal
What bone is injured in a Bennet’s fracture?
1st metacarpal
What causes a Bennet’s fracture?
Forced hyperabduction of the thumb
List the carpal bones of the proximal row?
Scaphoid
Lunate
Triquetrum
Pisiform
List the carpal bones in the distal radius?
Trapezium
Trapezoid
Capitate
Hamate
What vessel is at risk in a scaphoid fracture?
Dorsal carpal branch of radial artery
Where does 75% of breast lymph drain?
Axillary lymph nodes
What nerve can be affected by axillary lymph node clearance
Long thoracic nerve
What is transmitted in the Guyon’s canal?
Ulnar neurovascular bundle including:
Ulnar nerve
Ulnar artery
Lymph nodes
Venae camitantes of ulnar artery
What forms the lateral border of the Guyon canal?
Hook of hamate
What forms the medial border of the Guyon canal?
Pisiform
Flexor carpi ulnaris
Adductor digiti minimi
What forms the roof of the Guyon canal?
Palmar canal ligament
What forms the floor of the Guyon canal?
Flexor retinaculum
In carpal tunnel syndrome, what muscle is unaffected?
Flexor pollicus longus
What muscle is responsible for increasing grip / increasing curvature of the hand?
Palmaris brevis
What are the contects of the anatomical snuffbopx?
Radial artery
Cephalic vein
Superficial branch of radial artery
What muscles are found in the axilla region?
Coracobrachialis
Biceps brachii
What forms the lateral wall of the axilla region?
Humerus
What forms the medial wall of the axilla region?
Serratus anterior
Thoracic wall
WHat forms the anterior wall of the axilla region?
Pectoralis major
What forms the posterior wall of the axilla region?
Subscapularis
Teres major
Latissimus dorsi
Where is the axilla region found?
Underneath the glenohumeral joint
What condition is cuased when the axilla region is compressed?
Thoracic outlet syndrome
What condition is caused when the axilla region is compressed?
Thoracic outlet syndrome
What forms the roof of the carpal tunnel?
Flexor retinaculum
What are the clinical signs of De Quervian’s tenosynovitis?
Pain at base of thumb
Unable to grasp and pinch
What muscles are found in the anterior compartment of the upper arm?
Bracialis
Biceps Brachii
Coracobrachialis
Where does the long head of the biceps brachii attach?
Scapula - on the supraglenoid tubercle
What nerve innervates the anterior compartment of the upper arm
Musculocutaneous
(radial does help innervate the brachialis)
What nerve root is tested in the bicep tendon reflex?
C6
What is damaged when Popeye’s sign is seen?
Rupture of long head of the biceps brachii
What muscles are found in the posterior compartment of the upper limb?
Triceps brachii
What artery supplies the blood supply to the anterior compartment of the upper arm?
Brachial artery
What is the arterial supply to the posterior compartment of the upper arm?
Profunda Brachii artery
What nerve supplies the posterior compartment of the upper arm?
Radial nerve
What nerve root is tested when eliciting triceps refelx?
C7
Where does the long head of the triceps brachii originate?
Infraglenoid tubercle
What is the main nerve supply to the arnterior forearm?
Median nerve
What muscle can be absent in 15% of the population?
Palmaris longus
What mvoements are the anterior foearm compartment muscles reponsible for?
Pronation forearm
Flexion of wrist
Flexion of fingers
List the 5 main arterial vessels of the upper limb from proximal to distal?
Subclavian
Axilary
Brachial
Radial
Ulnar
Where do the subclavian arteries originate from?
On the right: Brachiocephalic trunk
On the left: Aorta
What are the superficial veins of the upper lomb?
Cephalic
Basilic
What upper limb vein is most commonly used for venepuncture?
Medial cubital vein
Where is the deep venous system of the upper limb found?
Under the deep fascia
What are the deep veins of the upper limb?
Paired vessels
Aka vena comitantes
Run alongside the brachial artery
List the components of the flexor pulley system
Long flexor tendons (and their assoc synovial sheaths)
Annular pulleys
Cruciate pulleys
Oblique pulleys
How many annular pulleys are there?
5 in each finger - 2 with thumb
How many cruciate pulleys are there?
3 acssociated with each finger
How manyt oblique pulleys are there
One - assocaited ith the thimb
Where do the long flexor tendons originate from?
The flexor digitorum superficialis
What pulley is most commonly assocaited with trigger finger?
A1
What type of joints are the PIPS?
Synovial hinge joint
What type of joint is the sternoclavicular?
Saddle type synovial joint
What 3 structures are involved in the sternoclavicular joint?
Sternal manubrium
Sternal end of clavicle
1st costal cartilage
What 2 ligaments connects the scapula and the clavicle?
Conoid ligament
Trapezoid ligament
aka coracoclavicular ligement
Fractures of the anatomical humeral neck are high risk for what?
How should they be managed>
Avascular necrosis
Hemiarthroplasty / surgical intervention
How is a fracture to the surgical neck of humeral head typically managed?
Collar and cuff for three weeks then physiotherapy.
Note: displaced fractures may require open reduction and fixation
What is a hills-sach lesion associated with?
Glenohumeral dislocation
