Upper limb

Question 1

Pectoralis Major

Answer 1

From: Upper 6 costal cartilages, medial 1/3 clavicle and sternum

To: Anterior axillary fold

Function: Adduction, flexion and medial rotation of the arm

Nerve: C5-T1 via lateral and medial pectoral nerves

Question 2

Pectoralis Minor

Answer 2

From: Ribs 3-5

To: Coracoid process

Function: Stablises scapula and depresses shoulder

Innervation: C8-T1 via medial and lateral pectoral nerves

Question 3

Trapezius

Answer 3

From: Occipital protuberance + cervical and thoracic vertebrae

To: Spine of scapula and lateral 1/3 of clavicle

Function: Elevation, retraction and rotation of scapula and stablises the shoulder backwards

Innervation: Cranial nerve XI: the spinal accessory nerve

Question 4

Sterno-clavicular and acromio-clavicular joints

Answer 4

Fibrocartilage with articular discs

Stability from ligaments

Allow pectoral movement

Question 5

Acromio-clavicular joint injury

Answer 5

Common following a fall where the force is transmitted to the shoulder

Disruption of acromio-clavicular ligament and coraco-clavicular ligaments

Causes acromion to sit inferior to the clavicle and become more prominent

Question 6

Serratus anterior

Answer 6

From: Lateral surface of ribs 1-8

To: Medial border of scapula

Function: Rotates scapula (for abduction), protracts scapula and holds scapula against the chest wall

Innervation: C6-7 long thoracic nerve

Question 7

Latissimus dorsi

Answer 7

From: T6-L5 and iliac crest (thoracolumbar fascia)

To: Intertubercle groove of humerus

Function: Adduction of arm, medial rotation of arm and raises the body towards the arm while climbing

Innervation: C6-7 - thoracodorsal nerve

Question 8

Subscapularis

Answer 8

From: subscapular fossa

To: lesser tubercle of humerus

Function: Medial rotation and adduction of the arm

Innervation: C5-7 - subscapular nerves

Question 9

Teres major

Answer 9

From: lower angle of scapula

To: intertubercular sulcus of humerus

Function: adduction and medial rotation of the arm

Nerve supply C5-7 - lower subscapular nerve

Question 10

Axillary artery

Answer 10

From: subclavian artery at lateral border of the 1st rib

To: Brachial artery and the inferior border of teres minor

Supplies: circumflex and humeral arteries

Other: split in to 3 by pectoralis minor (number of parts = number of branches in each part)

Question 11

Brachial plexus injuries

Answer 11

Waiters tip: superior brachial plexus injury. Separation of neck from shoulder

Claw hand: inferior brachial plexus injury. Sudden pull of arm superiorly

Question 12

Base of the breast

Answer 12

2-6th ribs

Mid-axillary line

Lateral sternal edge

Axillary tail: extends laterally under pectoralis

Question 13

Lymphatic drainage of the breast

Answer 13

Lateral 1/2 drains to the axillary nodes:

• 75% anterior
• apical
• lateral
• central

Medial 1/2 drains to the parasternal nodes

Other areas of drainage: posterior intercostal nodes, infraclavicular and supraclavicular nodes

Sites for metastasis: other breast, anterior abdominal wall

Question 14

Chest drain

Answer 14

5th intercostal space (although higher in pregnancy)

Mid-axillary line lateral to the edge of the breast

Question 15

Supraspinatus

Answer 15

Function: initiates abduction of the arm

Innervation C4-6 suprascapular nerve

Question 16

Infraspinatus

Answer 16

Function: lateral rotation of the arm

Innvervation C4-6 suprascapular nerve

Question 17

Teres minor

Answer 17

Function: lateral rotation of the arm

Innvervation C5+6 axillary nerve

Question 18

Deltoid

Answer 18

Function: Anterior flexion and medial rotation, Mid abduction of the arm, post extension and lateral rotation

Innervation C5+6 axillary nerve