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MRCS A > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

Where is the origin of the clavicular head of the pectoralis major?

A

medial half of the anterior surface of the clavicle

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2
Q

Where is the origin of the sternocostal head of the pectoralis major?

A

anterior surface of the sternum
upper 6 costal cartilages
EOA

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3
Q

Where is the insertion of the pectoralis major?

A

Lateral lip of bicipital groove

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4
Q

Nerve supply of pectoralis major

A

medial and lateral pectoral nerves

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5
Q

insertion of pectoralis minor

A

Coracoid process of the scapula

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6
Q

Nerve supply of pectoralis minor

A

medial pectoral nerve

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7
Q

Origin of serratus anterior

A

by 8 digitations from outer surface of upper 8 ribs

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8
Q

Insertion of serratus anterior

A

ventral surface of the medial border of scapula

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9
Q

nerve supply of serratus anterior

A

long thoracic nerve

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10
Q

action of serratus anterior

A

fixing scapula to posterior thoracic wall so its paralysis leads to winging of scapula

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11
Q

What structures piercing through the clavi-pectoral fascia?

A

CLAF
Cephalic vein
Lateral pectoral nerve
Acromiothoracic artery
Fat, LNS

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12
Q

Insertion of latissimus dorsi

A

floor of bicipital groove

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13
Q

Nerve supply of trapezius

A

spinal accessory nerve (CN11)

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14
Q

Nerve supply of latissimus dorsi

A

Nerve to latissimus dorsi (thoraco-dosral nerve)

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15
Q

Action of trapezius

A

Shoulder abduction from 90-180 (along with serratus anterior)
Shrugging of the shoulders

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16
Q

Abduction of the shoulder between 0 to 15 degrees

A

supraspinatus

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17
Q

Abduction of the shoulder between 15 to 90 degrees

A

muscle fibres of the deltoid

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18
Q

Abduction of the shoulder between 90 to 180 degrees

A

coupling action of serratus anterior and trapezius

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19
Q

What three muscles are attached at the bicipital groove?

A
  1. Pectoralis major = lateral lip
  2. Latissimus dorsi = floor
  3. Teres major = medial lip
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20
Q

What three muscles are attached at the greater tuberosity?

A
  1. Supraspinatus
  2. Infraspinatus
  3. Teres minor
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21
Q

Where is the origin of the supraspinatus muscle?

A

supraspinous fossa

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22
Q

Where is the origin of the infraspinatus muscle?

A

infraspinous fossa

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23
Q

Where is the origin of subscapularis muscle?

A

Subscapular fossa

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24
Q

Where is the insertion of the subscapularis?

A

Lesser tuberosity of the humerous

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25
Q

What nerve supplies the supraspinatus + infraspinatus?

A

Suprascapular nerve

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26
Q

What muscles are supplied by the axillary nerve?

A

teres minor
deltoid

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27
Q

Origin of the teres minor

A

upper 2/3 of lateral border of scapula

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28
Q

Origin of the teres major

A

Lower 1/3 of lateral border of scapula

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29
Q

Insertion of the teres major

A

Medial lip of the bicipital groove

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30
Q

What are the rotator cuff muscles

A

Above = supraspinatus
In front = subscapularis
Behind = infraspinatus + teres minor
Below = not supported –>** common dislocation**

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31
Q

Contents of the quadrangular space

A

Axillary nerve
Posterior circumflex humeral artery

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32
Q

Contents of the upper triangular space

A

Circumflex scapular artery

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33
Q

Contents of the lower triangular space

A

Radial nerve
Profunda brachii artery

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34
Q

What are the important contents of the axilla?

A

Intercostobrachial nerve = lateral cutaenous branch of 2nd intercostal nerve
Long thoracic + thoraco-dorsal nerve
(commonly injured in axillary node clearance)

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35
Q

Draw the brachial plexus from the roots to the cords

A

Roots (C5 to T1)
Trunks (upper = C5/6, middle = C7, lower = C8/T1)
Divisons (each trunk into ant and post)
Cords (post = all post divisions, lateral = anterior of upper/middle, medial = anterior of lower)

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36
Q

What nerves branch off the lateral cord?

A
  1. Lateral pectoral (C5-7)
  2. Lateral root of median nerve (C5-7)
  3. Musculocutaenous nerve (C5-7)
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37
Q

What nerves branch off the medial cord?

A
  1. Medial pectoral nerve (C8/T1)
  2. Medial root of median nerve (C8/T1)
  3. Ulnar nerve (C7/C8/T1)
  4. Medial cutaenous nerve of arm and forearm (C8/T1)
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38
Q

What nerves branch off the posterior cord?

A

ULNAR
1. Upper subscapular (C5/6)
2. Lower subscapular nerve
3. Nerve to latissimus dorsi - thoracodorsal N. (C6/7/8)
4. Axillary nerve (C5/6)
5. Radial nerve (C5/6/7/8/T1)

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39
Q

What is the result of an injury to the upper trunk (C5/6)?

A

Erb’s palsy

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40
Q

What is the motor impairment from Erb’s palsy?

A

The shoulder is:
* adducted (from supraspinatus + deltoid)
* internally rotated (from infraspinatus + teres minor)

The elbow is:
* extended + pronated (from biceps, brachialis, brachioradialis)

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41
Q

What is the sensory loss of Erb’s palsy?

A

Loss of sensation on radial side of arm + forearm

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42
Q

What are deformities noted in Erb’s palsy?

A

Policeman tip paralysis
Waiter’s tip deformity

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43
Q

What is the result of an injury to the lower trunk (C8/T1)?

A

Klumpke’s paralysis

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44
Q

What is the motor impairment from Klumpke’s paralysis?

A
  • Paralysis of intrinsic muscles in hand
  • Hyperextension of MCP and flexion of IP joints
  • Paralysis of wrist flexors
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45
Q

What is the sensory impairment from Klumpke’s paralysis?

A

Loss of sensation over ulnar border of forearm and arm

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46
Q

What deformity is seen from Klumpke’s paralysis?

A

Klumpke’s paralysis
Complete claw hand

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47
Q

What are the branches of the axillary nerve?

A
  • Articular branch = to shoulder joint
  • Muscular branch = to deltoid + teres minor
  • Cutaenous branch = to skin over upper 1/2 of lateral side of arm
48
Q

Cause of axillary nerve injury

A

fracture of surgical neck of humerus

49
Q

Sensory loss from axillary nerve?

A

Loss over skin of upper part of lateral arm

50
Q

Motor effect of axillary nerve

A

paralysis of deltoid + teres minor = loss of abduction of arm (15-90)

51
Q

Deformity from axillary nerve injury

A

flat shoulder due to atrophy of deltoid

52
Q

Origin of axillary artery

A

Outer border of first rib

53
Q

termination of axillary artery

A

lower border of teres major

54
Q

Course of axillary artery

A

crossed by pectoralis minor + divided into 3:
1. above muscle
2. behind muscle
3. below muscle

55
Q

Branches of axillary artery at 1st part

A

Superior throacic artery

56
Q

Branches of axillary artery at 2nd part

A
  1. Acromiothoracic artery
  2. Lateral throacic artery
57
Q

Branches of axillary artery at 3rd part

A
  1. Anterior circumflex humeral artery
  2. Posterior circumflex humeral artery
  3. Subscapular artery
58
Q

What muscles form the anterior group of arm?

A
  1. Coracobrachialis
  2. Brachialis
  3. Biceps
59
Q

Where is the origin of the coracobrachialis?

A

Tip of coracoid process in common origin with short head of biceps

60
Q

Where is origin of short head of biceps?

A

tip of coracoid process

61
Q

Where is origin of long head of biceps?

A

from supraglenoid tubercle

62
Q

Where is the insertion of the brachialis?

A

ulnar tuberosity

63
Q

Where is the insertion of the biceps?

A

By tendon in radial tuberosity

64
Q

What muscles of the arm are supplied by the musculocutaenous nerve?

A

Coracobrachialis
Biceps
Medial part of the brachialis

65
Q

What muscles of the arm are supplied by the radial nerve?

A

Lateral part of the brachialis
Triceps

66
Q

What is the action of the biceps?

A

Flexion of the elbow + shoulder joint
Powerful supination of forearm

67
Q

Where is the origin of the long head of the triceps?

A

From infraglenoid tubercle of scapula

68
Q

Where is the origin of the lateral head of the triceps?

A

From back of humerus above spiral groove

69
Q

Where is the origin of the medial head of the triceps?

A

From back of humerus below the spiral groove

70
Q

What is the main action of the triceps?

A

Extensor of the elbow joint

71
Q

What are the boundaries of the cubital fossa?

A

Lateral = brachioradialis
Medial = pronator teres
Floor = brachialis

72
Q

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

A
  1. Median Nerve
  2. Brachial Artery
  3. Biceps Tendon
  4. Radial Nerve

MBBR

73
Q

Name the five superficial flexors of the forearm

A
  1. Pronator teres
  2. Flexor carpi radialis
  3. Palmaris longus
  4. Flexor carpi ulnaris
  5. Flexor digitorum superficialis
74
Q

What superficial flexors of the forearm are supplied by the median nerve?

A

Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor digitorum superficialis

75
Q

What superificial flexors of the forearm are supplied by the ulnar nerve?

A

Flexor carpi ulnaris

76
Q

What is the insertion of the flexor digitorum superficialis?

A

Muscle is divided into 4 tendons + inserted into the middle phalanges of the medial 4 fingers

77
Q

Name the three deep flexors of the forearm.

A
  1. Flexor pollicis longus
  2. Pronator quadratus
  3. Flexor digitorum profundus
78
Q

What nerve supplies the deep flexors of the forearm

A

anterior interosseous nerve

79
Q

What nerve supplies the ulnar side of the flexor digitorum profundus?

A

Ulnar nerve

80
Q

What is the insertion of the flexor digitorum profundus?

A

Base of distal phalanges of medial 4 fingers

81
Q

Name the 7 superficial extensors of the forearm

A
  1. Brachioradialis
  2. ECRL
  3. ECRB
  4. Extensor digitorum
  5. Extensor digiti minimi
  6. Extensor carpi ulnaris
  7. Anconeous
82
Q

Name the 5 deep extensors of the forearm

A
  1. Supinator
  2. Abductor policis longus
  3. Extensor policis brevis
  4. Extensor polices longus
  5. Extensor indices
83
Q

What is the nerve supply to the extensors of the forearm?

A

Posterior interosseous nerve (branch of radial), except for the BEAT muscles, which are supplied by the radial nerve.
Brachioradialis
ECRL
Anconeous
Triceps

84
Q

What is the insertion of the extensor digitorum?

A

Extensor expansion of the medial 4 fingers

85
Q

What is the distance between the ulnar nerve to ulnar artery?

A

1cm

86
Q

What is the flexor retinaculum?

A

Thickened band of deep fascia lies in front of the carpal bones, converting the concavity on their anterior surface into a tunnel.

87
Q

What are the lateral attachments of the flexor retinaculum?

A

to the scaphoid + trapezium

88
Q

What are the medial attachments of the flexor retinaculum?

A

Pisiform + hook of hamate

89
Q

What structures are superficial to the flexor retinaculum?

A
  • ulnar nerve
  • ulnar artery
  • palmar cutaneous branch of ulnar nerve
  • palmer cutaneous branch of median nerve
  • palmaris longus tendon
90
Q

What structures are deep to the flexor retinaculum?

A

Dr PM
Digitorum (FDS, FDP)
Radialis muscle (FCR)
Policis muscle (FPL)
Median nerve

91
Q

What are the names of the carpal bones?

A

made of two rows of 4 bones
She Looks Too Pretty, Try To Catch Her
Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate.

92
Q

What nerve supplies the adductor pollicis?

A

Ulnar Nerve

93
Q

What muscles are supplied by the median nerve?

A

LOAF
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

94
Q

What is the origin of the median nerve?

A

Lateral root from lateral cord
Medial root from medial cord

95
Q

Course of median nerve in axilla + arm?

A

LAM
Lateral to upper 1/2 of brachial artery
Anterior to brachial artery
Medial to lower 1/2 of brachial artery

96
Q

What does the median nerve supply in the forearm?

A

PT, FCR, PCL, FDS

97
Q

What does the anterior interosseous nerve supply in the forearm?

A

FPL, PQ + Lateral 1/2 of FDP

98
Q

What is the sensory innervation by the median nerve?

A

Lateral 2/3 of palm
Palmar surface of lateral 3.5 fingers

99
Q

Motor injury to median nerve

A

Paralysis of:
1. thenar muscles –> flattening in thenar eminence + loss of thumb opposition
2. lateral 2 lumbricals
3. PT + PQ –> loss of pronation
4. Flexors of forearm (except FCU + medial 1/2 of FDP) –> weak flexion of wrist with ulnar deviation due to unopposed action of FCU

100
Q

Deformity presentation of median nerve

A

Ape-like hand

101
Q

Cause of injury to anterior interosseous nerve

A

Supracondylar fracture humerus in children

102
Q

Origin of ulnar nerve?

A

Medial cord of brachial plexus

103
Q

Ulnar nerve supply to what muscles in forearm?

A

FCU, medial 1/2 of FDP

104
Q

Ulnar nerve supply to what muscles of hand?

A

Adductor policis muscle
Hypothenar
Palmar + dorsal interossei
3rd/4th lumbricals

105
Q

Injury to the ulnar nerve causes…

A

Paralysis of:
1. adductor policis –> abducted thumb
2. hypothenar –> atrophy + flattening of hypothenar eminence
3. Interossei + lumbricals –> loss of adduction + abduction, loss of extension of IP –> clawing
4. FCU –> lateral deviation of hand

106
Q

What deformity is noted when ulnar nerve injured?

A

Clawing -
Ulnar paradox (higher the lesion the less clawing, lower the lesion the more clawing)

107
Q

What are the boundaries of the snuff box?

A

Medial = EPL tendon
Laterally = tendons of APL, EPB
Floor = Scaphoid, Tendons of extensor carpi radialis longus + brevis
Roof = skin + fascia

108
Q

What are the contents of anatomical snuff box?

A

Radial artery
Radial nerve
Cephalic vein
Tendons of ECRL + ECRB

109
Q

What is the blood supply to the scaphoid bone?

A

from the distal end by the radial artery
AVN to proximal part of scaphoid

110
Q

What are the thenar muscles (lateral)?

A

Abductor policis brevis
Flexor policis brevis
Opponens policis brevis
Adductor policis

111
Q

What is the action of the interossei?

A

PAD
Palmar = ADduction
Dorsal = ABduction

112
Q

Origin of radial nerve?

A

Posterior cord of brachial plexus

113
Q

What is the course of radial nerve?

A

Passes in the lower triangular space, and into the spiral groove downward + lateral between lat/med head of triceps

114
Q

What is the motor consequence of injury to radial nerve?

A

Loss of extension in:
- fingers = fingers drop
- wrist = wrist drop
- elbow = paralysis of triceps muscle
Loss of supination

115
Q

Cause and consequence of posterior interosseous nerve

A

during lateral approach to elbow
Loss of motor function only –> finger drop
No sensory loss

116
Q

What is the drainage of the basilic vein?

A

Into the axillary vein

MRCS A (3 decks)

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