Upper Limb Flashcards
Draw the brachial plexus
HAHAHAHAH
Deltopectoral approach set up?
GA, supine, arm abducted and on radiolucent board
Landmarks and incision for deltopectoral approach?
Acromion, clavicle. coracoid. From coracoid along deltopectoral groove
Why deltopectoral approach?
Extensible, east access to anterior shoulder joint
First thing to identify and preserve along groove?
cephalic vein with its fat layer- reflect medially- have to tie off tributies to deltoid when dissecting
Fascia to expose in groove?
Clavipectoral fascia
What tendon is underneath the clavipectoral fascia?
conjoined tendon- made up of short head of biceps and coracobrachialis attaching onto the coracoid
What muscles make up the rotator cuff?
Subscapularis- internal rotation
Supraspinatus- abduction
Infraspinatus- external rotation
Teres minor- external rotation
Quadrangular space contents and boarders?
Axillary nerve, posterior circumflex humeral vessels
Teres minor
Triceps
Teres major
humerus
Triangular space contents and boarders?
Circumflex scapular artery
Teres minor
Teres major
Triceps
Triangular interval contents and boarders?
Radial nerve
Teres major
Triceps
Triceps
Incision for deltoid splitting approach?
Anterior acromion, 4-6 cm distally along deltoid
Where should you divide the deltoid?
between the anterior and middle third, normally a fatty streak is present
What to watch out for in deltoid splitting approach?
Axillary nerve- therefore do not extend too inferiorly,
damage will cause loss of flex only
Where is the worse place to damage the axillary nerve?
Just below the humeral neck
Internervous plane of deltopectoral approach?
Medial and lateral pectoral- pec major
axillary- deltoid
Internervous plane for henry’s approach to humerus
between the brachialis (musculocutaneous n. and radial n., deltoid insertion divides the muscles innervation)
brachioradialis (radial n.)
Use of henry’s approach to humerus?
Access to proximal 4/5ths of humerus
Landmarks for henry’s humerus?
Coracoid process, bicipital tubercule on radial head
Incision for henry humerus?
Lazy s across joints, make a curved incision over the lateral border of the biceps centered over the fracture site
What muscle identify and reflect/divide for henry’s humerus?
The brachialis and biceps are retracted medially and the brachioradialis laterally
What nerves needed to be identified and avoided, where do they lie for henry’s humerus?
Radial nerve- between brachialis and brachioradialis
Lateral antebrachial nerve- This terminal branch of the musculocutaneous nerve is injured at the distal end of the incision as it exits the biceps laterally
Use of posterior approach to humerus?
access to inferior 2/3rds of humerus
Landmarks for posterior approach to humerus?
medial and lateral epicondyles, olecranon, deltoid insertion on the humerus.
