Upper limb Flashcards
Which structure does cephalic vein pierce
Clavipectoral fascia
How many dorsal interrossei are there
4
2 heads at base
How many palmar interrossei are there
3
Which nerve supplies nailed of index finger
Median
Ulnar nerve related to artery at wrist
Artery is radial
If axillary artery is ligated which artery would have a reversal of flow
Circumflex scapular
Which strcuture is most likely to be damaged with laceration to lateral side of extensor retinaculum
Superficial radial nerve
Branches of radial nerve
Lateral cutaneous of arm
Posterior cutaneous of arm
Posterior cutaneous of forearm
Superficial sensory to hand
PIN- continuation of deep
Which muscles does the PIN innervate
ECU
ED
EDM
APL
EPL
EPB
EI
So only doesn’t innervate ECR brevis and longus, radiobrachialis and aconeus - all innervated by deep radial
Branches of ulnar nerve
Muscular- branches in forearm
Palmar cutaneous- medial half of palm
Dorsal- dorsal half and muscles in hand
Branches of median nerve
AIN- nerves of forearm
Palmar cutaneous- sensory in hand
Recurrent- thenar muscles
Palmar digital branch – innervates the palmar surface and fingertips of the lateral three and half digits. Also innervates the lateral two lumbrical muscles.
Median nerve in relation to brachial artery throughout upper limb
Lateral in arm
Crosses over anterior to medial just before ACF
Medial at ACF
Where can the PIN get trapped and what effect does this cause
Arcade of Frohse which is a superficial part of the supinator muscle which overlies the posterior interosseous nerve.
This nerve is entirely muscular
Which muscles does AIN innervate
FPL
Flexor pollicis longus
PQ
Lateral FDP
Sensory innervation of arm
Lateral arm- radial branch
Posterior arm- radial branch
Medial arm and forearm- medial antecubital
Lateral forearm- lateral antecubital- branch of musco
Hand
Palmar
Median- 3.5
Ulnar- medial 1.5
Dorsal
Radial up until finger tips lateral 3.5
Ulnar medially 1.5
If little finger infected where it the most proximal it can spread to
Flexor retinaculum as tendon sheath extends to this
Other finger tendon sheath stop at base of digit
Nerve at risk with humeral surgical neck fracture
Axillary nerve
What does the posterior cord of brachial plexus give rise to
Radial
Axillary
Upper subscapular- subscapularis
Lower subscapular - teres major
Thoracodorsal
ULNAR
Nerves arising from medial cord of brachial plexus
Ulnar
Median
Medial pectoral nerve (C8, T1)
Medial brachial cutaneous nerve (T1)
Medial antebrachial cutaneous nerve (C8, T1)
Nerves arising from lateral cord of brachial plexus
Muscocutaneous
Median
Lateral pectoral (C5, C6, C7
What separates cephalic vein and brachial artery in ACF
Bicep aponeurosis
Which muscles flexes IP vs MCP joint of thumb
FPL- IP
FPB- MCP
What is the Gantzer muscle and its innervation
Accessory of FPL
So AIN
What attaches periosteum to bone
Sharpey Fibres
Which finger does the palmar interossei not attach to
Middle
Venous drainage of upper limb
Basillic medially- joins Brachial to form Axillary
Cephalic joins axillary
Course of median nerve relative to brachial artery
Lateral, anterior, medial
Which upper limb muscle dose not insert onto radius
Brachialis
Which muscle is attached to anterior aspect of fibrous capsule
Brachialis
Which structure lies closest to hamate in carpal tunnel
Median nerve
Laceration, loss of pincer movement of thumb and index finger, no loss of sensation
AIN
Which nerve is damaged in a Crutch palsy and what symptoms
Radial
Wrist drop
Saturday night palsy
Surgical Treatment of hyperhidrosis of hands and arms
Divide sympathetic ganglia at T2,3
Nerve damaged with surgical neck of humerus fracture
Axillary
An MRI scan shows a small cuff of tendon still attached to the radial tuberosity consistent with a recent tear. Which of the following muscles has been injured?
Bicep brachii
What separates ulnar artery and median nerve
Pronator teres
Ulnar lies deep
Where does the shoulder joint insert
The fibrous capsule attaches to the anatomical neck superiorly and the surgical neck inferiorly
What are the defects in the fibrous capsule of shoulder
Two defects in the fibrous capsule; superiorly for the tendon of biceps. Anteriorly there is a defect beneath the subscapularis tendon.
Where does scaphoid receive majority of its blood
Dorsal carpal branch of radial artery
What articulates with radial head
Capitulum
Capital Radio
What articulates with olecranon
Trochlear
Where do the rotator cuffs insert
Greater tuberosity of humerus
Apart from subscapularis- lesser
Teres major -not RC but inserts into intertubercular sulcus
Anatomical relations of shoulder jointW
Anteriorly
Brachial plexus
Axillary artery and vein
Posterior Suprascapular nerve
Suprascapular vessels
Inferior
Axillary nerve
Circumflex humeral vessels
Which part of shoulder capsule is related to axillary nerve
The inferior extension of the capsule is closely related to the axillary nerve at the surgical neck and this nerve is at risk in anteroinferior dislocations
Radial nerve relation to humerus at supracondylar area
Anterolateral
Where does Pin leave antecubital fossa
Between 2 heads of supinator
Where does cephalic vein form
Anatomical snuff box
Which nerve does basilica vein follow in forearm
Medial cutaneous
Which nerve does cephalic vein follow in forearm
Lateral cutaneous
Where does brachial artery bifurcate
Opposite neck of radius
Beneath bicipital aponeurosis
Largest branch of brachial artery
Ulnar
Branches of radial artery
Recurrent radial- arrises from lateral aspect and anastomoses with radial collateral of brachial profunda
Guyon canal borders and content
Medial (ulnar) – pisiform, flexor carpi ulnaris tendon, abductor digiti minimi muscle.
Lateral (radial) – hook of hamate.
Roof – palmar carpal ligament.
Floor – flexor retinaculum, pisohamate ligament, and hypothenar muscles.
Contains ulnar nerve and artery
Which bone articulates with scaphoid on lateral aspect
Trapezium
Anatomical location of the base of the breast
2-6th rib vertically
Lateral border of sternum and MAL
Course of radial artery
Under BR
Emerge on medial aspect
Floor of anatomical snuff
Piece between 2 heads of 1st interosseous
5 superficial upper limb muscles
FCU, PL, PT, FCR
FDS- intermediate
3 deep muscles of upper limb
FPD, FPL, PQ
Pec minor attachments
3-5th rib to coracoid
Arterial and nerve supply of rhomboids
Dorsal scapula
Border of axilla
Ant- pec major and minor
Post- teres major, lat doors, subscapularis
Medial- serrates anterior and thoracic wall
Lateral- intertubecular sulcus
Level of nodes relative to pec minor
1- lateral
2- behind
3- medial
Muscles median nerve passes between to enter wrist
FDS and FPL
What encloses axillary vessles and brachial plexus
Axillary sheath
Brachial artery branches
Profunda brachii (P)
Nutrient artery of the humerus (N)
Superior ulnar collateral artery (S)
Middle ulnar collateral artery (M)
Inferior ulnar collateral artery (I)
Nerves arrises from brachial plexus roots
Long thoracic
Nerve to subclavius
Dorsal scapula
Nerves arising from trunks of brachial plexus
Suprascpaular
Dorsal guttering
Wasting of dorsal interossei
How does palmar cutaneous nerve of median enter hand
Superficial to flexor retinaculum
Annular ligament Goes around
Encircles head of radius
Ligaments of elbow
Radial collateral - lateral epicondyle blends in with annular
Ulnar collateral - medial epicondyle to coronoid and olecranon of ulnar
Annular
Where does ulnar nerve enter forearm
Between 2 heads of FCU in cubital tunnel
Borders of cubital tunnel
Medial wall – medial epicondyle of the humerus.
Lateral wall – olecranon of the ulna
.
Floor – elbow joint capsule and medial collateral ligament of the elbow.
Roof – cubital tunnel retinaculum or the arcuate ligament of Osbourne
Test for AIN
Flex at IPJ of thumb
Nerve supply of teres minor
Axillary
Involvement of which nerve root might result in Horners
T1
Hand of benediction
High median nerve damage
Tries to make a fist
Unable to flex DIP or PIPJ due to paralysis of both FDS and lateral FDP
Patient weak extender of shoulder which nerve affected
Thoracodorsal
Borders of cubital fossa
Proximal- line connecting medial and lateral epicondyles
Medial- pronator teres
lateral- brachioradialis
Roof- bicipital aponeurosis
Floor- brachial and supinator
Brachial artery relative to bicep brachial
Medial
Medial to tendon in fossa too
Lateral to median
Brachial artery, biceps tendon, , median nerve order in fossa
Lateral to medial
Biceps
Brachial
Median
Global wasting of hand muscles nerve root damage
T1
or C8
As effects both ulnar and median
Where does median cross brachial
In mid arm
From lateral to medial
Intercostalbrachial nerve root and supply
T2
Sensation of medial arm and axilla
Nervous supply of breast
Anterior branches of 1-6th intercostal medially
Lateral 2-7th intercostal
Breast coverage of pec major and serrates anterior
2/3 of breast covers pec
1/3 covers serrates
Where does axillary form and end
The axillary artery commences from the subclavian artery at the outer border of the first rib and terminates when it becomes the brachial artery at the outer border of the teres major muscle.
Where does basilica vein pierce deep fascia
Halfway between elbow and axilla
Where does rotters node lie
Between pec minor and major
