Upper Limb Flashcards
What muscles does the Median nerve supply?
- PL
- FDS
- PT
- FCR
- Abductor pollicis
- Flexor pollicis
- Opponens pollicis
- 1st and 2nd lumbricals
What nerve must be assessed following dislocation of shoulder?
Axillary Nerve
What fracture can damage Radial Nerve?
Transverse fracture of humerus
Where is the radial nerve?
Spiral groove
What muscle is tested with Froments test?
Adductor pollicis
What nerve supplies adductor pollicis?
Ulnar nerve
What type of joint is the glenohumeral joint?
Synovial joint
What is painful arc syndrome ?
Pain on abduction between 45 - 160 degrees (middle third of arc)
What does supraspinatus do?
1st 10-15 degrees of abduction
Colles fracture?
Transverse fracture of radius just above wrist, with dorsal displacement of distal fragment
Late complication of colles fracture?
Extensor pollicis longus rupture
How should a traumatically amputated digit be transferred?
Wrapped in saline soaked gauze chilled in ice water and labelled
What nerve roots are affected in Erbs palsy?
C5, C6 sometimes C7
What nerve roots are affected in Klumpkes palsy?
T1
What happens with T1 damage?
- Weak wrist and finger flexors
- Intrinsic hand muscles paralysed
- Horners syndrome
- Loss of sensation ulnar forearm
Where is median nerve most commonly injured?
Wrist
What nerves are in direct contact with the humerus?
- Radial
- Axillary
- Ulnar
Pectoral girdle?
- Clavicle
2. Scapula
Where does the long thoracic nerve run?
Superficial course along medial wall of axilla
Wrist flexion?
- FCR
2. FCU
Wrist extension?
- ECRL
- ECRB
- ECU
What nerve supplies the interossei muscles?
Ulnar nerve
Where is guyons tunnel?
Medial side of anterior wrist
What are the borders of guyons canal?
- Floor - flexor retinaculum
- Roof - palmar carpal ligament
- Medial - pisiform
- Lateral - hamate
Flexion of proximal interphlangeal joints?
FDS ( median nerve)
What is claw hand a feature of?
Low ulnar nerve lesions
Mid to distal forearm
Flexion of 4th and 5th IPJ and extension of MCP joints
What happens with axillary compression of radial nerve?
- Triceps paralysis
- Wrist weakness
- Hand weakness
Fracture of mid humerus - high lesions , what happens?
- Weakness of radial Extensors of wrist (wrist drop)
2. Numbness over anatomical snuff box
What happens in Horners syndrome?
- Constricted pupil
2. Ptosis - upper lid drooping
What happens in a complete brachial plexus lesion?
- Damage to cervical sympathetic chain - Horners syndrome
- Whole upper limb paralysed
- Winging of scapula - serratus anterior
What does the dorsal scapular nerve innervate?
- Levator scapulae
- Rhomboid major
- Rhomboid minor
What is the most common dislocation of shoulder ?
Anterior
What is the most common mechanism of anterior dislocation of shoulder?
- Fall on outstretched arm
2. Arm abducted and externally rotated
What are the clinical signs of anterior dislocation?
- Swelling in deltopectoral groove
- Prominence of acromion
- Arm held in slight abduction and external rotation
- Maybe flattening and loss of contour of shoulder
- Lowering of anterior axillary fold
- ? Axillary nerve damage
What muscle inserts of to the crest of the lesser tubercle of the humerus?
Lower part of Subscapularis
What nerve is behind medial epicondyle of humerus?
Ulnar nerve
Damage here - radial deviation of wrist, clawing in 3rd and 4th digits
What cord of the brachial plexus does the ulnar nerve arise from?
Medial cord
Damage to the ulnar nerve at the level of the medial epicondyle?
- FCU
- Ulnar 1/2 of FDP
- interossei - loss of adduction of fingers
- Hypothenar muscles - loss of sensation
Boundaries of anatomical snuff box?
- Anterior - extensor pollicis brevis and abductor pollicis longus
- Posterior - extensor pollicis longus
- Proximally - radial styloid
- Floor - trapezium and scaphoid
What is the axillary vein formed by?
- Basilica vein
2. Vena comitantes of brachial artery
What nerve is affected when you can’t make the ok sign?
Anterior interosseous nerve (branch of medial nerve)
High radial nerve lesions ie # mid humerus?
- Weakness of radial Extensors of wrist
2. Numbness over anatomical snuff box
Low radial nerve lesion?
- Loss of digital extension
2. Loss of thumb extension
What movements are the dorsal interossei responsible for?
Finger abduction
What happens in Erbs palsy?
- Paralysis of abductors
- Paralysis of lateral rotators
- Paralysis Elbow flexors
- Paralysis of supinator
- Loss of cutaneous sensation over lateral aspect of arm
What are the hypothenar muscles?
- Palmaris brevis
- Opponens digiti minimi
- Flexor digiti minimi brevis
- Abductor digiti minimi
(All supplied by the ulnar nerve)
What structures are damaged with a laceration to the thenar eminence?
- Muscular branch of median nerve
2. Adductor pollicis muscle
What muscles does the deep branch of the ulnar nerve supply?
- Opponens digiti minimi
- Abductor digiti minimi
- Flexor digiti minimi
- 3rd and 4th lumbricals
- Dorsal and palmar interossei
- Adductor policis
- Deep head of flexor pollicis brevis
What does the superficial branch of the ulnar nerve supply?
Palmaris brevis
What cord of the brachial plexus make up the median nerve?
- Lateral cord
2. Median cord
What nerve roots contribute to the median nerve?
C6, C7, C8, T1
What is the blood supply to the latissimus dorsi?
Thoracodorsal artery
What are the root values of the musculocutaneous nerve?
C5, C6
What cord of the brachial plexus the musculocutaneous nerve arise from?
The lateral cord
Cephalic vein
Located in superficial fascia along anterolateral surface of biceps brachii muscle
Deltopectoral groove
Common flexor attachment
Medial epicondyle
- PT
- FCR
- PL
- FDS
- FCU
Flexion at elbow
- Biceps brachi
- Brachialis
Musculocutaneous nerve - gives rise to lateral ante brachial cutaneous nerve - sensory innervation anterolateral surface of forearm
Flexion of arm
- Biceps brachii
- Coracobrachialis
- Pectoralis major
Lower subscapular nerve (C5,C6)
- Lower part of Subscapularis
2. Teres major
Axillary nerve
- Teres minor
2. Deltoid
Suprascapular nerve
- Supraspinatus
2. Infraspinatus
Damage to ulnar nerve at wrist
- Wasting and paralysis of intrinsic muscles (claw hand)
- Wasting and paralysis of hypothenar muscles
- Loss of sensation medial 1 and 1/2 fingers
Quadrangular space
Anterior - Subscapularis Posterior - teres minor Below - teres major Medial - long head of biceps Lateral - surgical neck of uterus