Upper Limb

Question 1

What bones are part of the pectoral girdle?

Answer 1

clavicle
scapula
manubrium of sternum

Question 2

what is the blood supply to the upper limb?

Answer 2

subclavian
axillary
brachial

Question 3

At what point does the subclavian artery become the axillary artery?

Answer 3

When the subclavian arteries cross the lateral edge of the 1st rib, they enter the axilla, and are called axillary artery

Question 4

At what point does the axillary artery become the brachial artery?

Answer 4

The axillary artery becomes the brachial artery at the lateral border of the teres major muscle.

Question 5

Which arteries come off the axillary artery?

Answer 5

At the level of the humeral surgical neck, the posterior and anterior circumflex humeral arteries arise. They circle posteriorly round the humerus to supply the shoulder region. The largest branch of the humerus also arises here; the subscapular artery.

Question 6

Which artery does the brachial artery give off?

Answer 6

Profunda brachii
deep artery of the arm
runs on the posteior side of the arm along the radial groove

Question 7

At what point does the brachial artery branch to form the radial and ulnar arteries?

Answer 7

The brachial artery descends down the arm immediately posterior to the median nerve. As it crosses the cubital fossa, underneath the brachialis muscle, the brachial artery terminates by bifurcating into the radial and ulnar arteries. The two arteries anastamose in the hand, by forming two arches, the superficial palmar arch, and the deep palmar arch

Question 8

Explain what happens to a fractured clavicle

Answer 8

2-5 % of adult fractures
most common site is the junction at the lateral 1/3 and medial 2/3 of the clavicle.
The lateral end of the clavicle is pulled inferiorly by the arm, medially by pec major. The medial end is pulled superiorly by the SCM

Question 9

What does the clavicle protect?

Answer 9

brachial plexus
underlying vessels
apex of lung

Question 10

what are the movements of the scapula?

Answer 10

elevation/ depression
protatction/retraction
upward rotation/ downward rotation

Question 11

What are the movements at the glenohumeral joint?

Answer 11

flexion/extension
abduction/adduction
medial and lateral rotation
circumduction

Question 12

Which musles are the chief flexors at the glenohumeral joint?

Answer 12

pec major (clavicular part)
deltoid anterior
(coracobrachialis assisted by biceps brachii which stabilises the joint)

Question 13

Which muscles are the chief extensors at the glenohumeral joint?

Answer 13

Latissumus dorsi
Deltoid posterior
( teres major, long head of triceps brachii help stabilise the joint)

Question 14

Which muscles are the chief abductors at the glenohumeral joint?

Answer 14

deltoid
1st 10 degrees of abduction initiated by supraspinatus
180 degrees of shoulder abduction: 120 degress at glenohumeral joint and 60 degrees occurs at scapulothoracic joint

Question 15

Which muscles are the chief adductors at the glenohumeral joint?

Answer 15

pec major
lat dorsi
(gravity is prime mover)

Question 16

Which muscle is the chief medial rotator at the glenohumeral joint?

Answer 16

subscapularis

Question 17

Which muscle is the chief lateral rotator at the glenohumeral joint?

Answer 17

infraspinatus

Question 18

What are the 4 rotator cuff muscles?

Answer 18

supraspinatus
infraspinatus
teres minor
subscapularis

Question 19

Explain what happens in a dislocation of the glenohumeral joint

Answer 19

Mainly anterior dislocations. GH joint is fully abducted and tilts head of humerus inferiorly. The humeral head is forced anteriorly and inferiorly – into the weakest part of the joint capsule.
Glenoid labrum may be stripped and makes joint weaker
Arm is adducted and moves inferiorly
loss of rounded profile of shoulder

Question 20

What nerve can be damaged due to a dislocation of the shoulder joint?

Answer 20

Axillary nerve injury
leads to paralysis of deltoid and loss of sensation
test C5 dermatome

Question 21

Which lymph nodes are present in the axilla?

Answer 21

apical
central
pectoral
subscapular
humeral

Question 22

Where does the upper limb lymph mainly drain to?

Answer 22

humeral and central nodes

Question 23

What other lymphatics drain to axillary nodes?

Answer 23

lymphatics of the lateral breast drain into pectoral and subscapular lymph nodes

Question 24

What is the physiological scapulothoracic joint?

Answer 24

physiological joint formed by an articulation of the anterior scapula and the posterior thoracic rib cage. It is musculotendinous in nature and is formed predominantly by the trapezius, rhomboids and serratus anterior muscles

Question 25

What is winging of the scapula?

Answer 25

due to dysfunction of the serratus anterior The serratus anterior muscle originates from ribs 2-8, and attaches the costal face of the scapula, pulling it against the ribcage. The long thoracic nerve innervates the serratus anterior. If this nerve becomes damaged, the scapula protrudes out of the back when pushing with the arm.

Question 26

What can a radical mastectomy lead to?

Answer 26

Lymphoedema in the distal part of the upper limb, due to removal of lymph nodes after treatment

Question 27

What can axillary lymph node clearance lead to?

Answer 27

Injury to thoracodorsal nerve which supplies the latissimus dorse Injury to long thoracic nerve which supplies serratus anterior But trapezius has to work harder during abduction as serratus anterior is no longer available to help rotate the scapula

Question 28

What are the name of the joints at the elbow?

Answer 28

humeroulnar humeroradial proximal radioulnar

Question 29

Which nerve is at risk of injury due to a mid shaft humeral fracture?

Answer 29

Radial nerve | Sensory testing at the back of the hand on the first dorsal interosseus web of skin

Question 30

Which nerve is at risk of injury due to supracondylar fracture?

Answer 30

Median nerve | This fracture can lead to ischaemia of the rest of the arm due to compression of the brachial artery

Question 31

Which nerve is at risk of injury due to a medial epicondyle fracture?

Answer 31

ulnar nerve | it passes behind the medial epicondyle

Question 32

What muscles group attach to the medical epicondyle?

Answer 32

flexors of the forearm

Question 33

What type of joint is the elbow joint?

Answer 33

hinge joint | pivot joint

Question 34

What is found in the anterior compartment of the forearm?

Answer 34

``` flexors e.g flexor digitorium superficialis pronators median nerve ulnar nerve radial artery ulnar artery ```

Question 35

What is found in the posterior compartment of the forearm?

Answer 35

extensors e.g extensor digitorum supinators radial nerve posterior interosseus artery

Question 36

What joints are found in the hand?

Answer 36

``` distal radioulnar radiocarpal intercarpals carpometacarpals metacapalphalangeals interphalangeals ```

Question 37

What articulations are found at the wrist?

Answer 37

radius articulates with scaphoid and lunate | ulna does not articulate with carpals

Question 38

What is a Colle's fracture?

Answer 38

fracture of the radius. A fall onto an outstretched hand causing a fracture of the distal radius. The structures distal to the fracture (wrist and hand) are displaced posteriorly. It produces what is known as the ‘dinner fork deformity’.

Question 39

What is a Colle's like fracture?

Answer 39

fracture of radius and ulna.

Question 40

What is a Smith's fracture?

Answer 40

A fracture caused by falling onto the back of the hand. It is the opposite of a Colles’ fracture, as the distal fragment is now placed anteriorly.

Question 41

What is carpal tunnel syndrome?

Answer 41

Inflammation of a group of extensor muscle tendon sheath e.g adductor policus longus and extensor policus brevis leads to compression of the median nerve and atrophy of the thenar muscle group

Question 42

What are the name of carpal bones in the proximal row?

Answer 42

scaphoid lunate triquetrum pisiform

Question 43

What are the names of the carpal bones in the distal row?

Answer 43

trapesium trapezoid capitate hamate

Question 44

What is an Allan's test?

Answer 44

This tests for a blockage of the anastomoses of the radial and ulnar arteries in the hand The ulnar artey can be compressed, there is no collateral circualtion and radial artery supply may be insufficient

Question 45

What is the motor and sensory innervation of the musculocutaneous nerve?

Answer 45

Motor: flexors of the arm Sensory: skin over lateral forearm

Question 46

What is the motor and sensory innervation of the median nerve?

Answer 46

Motor: flexors of the forearm Sensory: skin over lateral palm (1-3.5 digits)

Question 47

What is the motor and sensory innervation of the ulnar nerve?

Answer 47

Motor: intrinsic hand muscles Sensory: skin over medial dorsal and plantar palm (3.5-5 digits)

Question 48

What is the motor and sensory innervation of the axillary nerve?

Answer 48

Motor: deltoid, teres minor Sensory: skin over deltoid

Question 49

What is the motor and sensory innervation of the radial nerve?

Answer 49

Motor: extensors of upper arm and forearm Sensory: skin over posterior arm and wrist. Dorsal hand (base of thumb and 1-3 digits)

Question 50

What muscles are flexors of the elbow?

Answer 50

biceps brachii | assisted by brachialis and brachioradialis

Question 51

What muscles extend the elbow?

Answer 51

Triceps brachii | assisted by anconeus

Question 52

What are the chief supinator muscles?

Answer 52

biceps brachii | supinator

Question 53

What are the chief pronator muscles?

Answer 53

``` pronator teres (elbow) pronator quadratus (wrist) ```

Question 54

What are the boundaries of the cubital fossa?

Answer 54

superior: imaginary line between medial and lateral epicondyles medial: pronator teres lateral: brachioradialis floor: brachialis and supinator roof: brachial and antebrachial fascia reinforced by bicipital aponeurosis