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.
Incision for posterior humerus?
Curve around olecranon
olecranon to deltoid attachment
Which muscles are to be split in post humerus?
short and long head of triceps
Which nerve andwhere? post humerus?
Radial nerve on middle head of biceps
Henry’s elbow use?
Vascular access to brachial artery- emergency
Long head of biceps rupture repair
Landmarks for henry elbow
5cm prox to flex crease
lateral boarder of biceps brachii
medial boarder of brachioradialis
Incision for henry elbow
Lazy s, follow medial boarder of brachioradialis
continue between brachioradialis and protnator teres
What neurovascular structures are at danger for henry’s elbow
Median cubital vein
medial antebrachial cutaneous nerve
Where does the long head of biceps insert?
radial tuberosity
Nerve vulverable in posterior approach to elbow?
ulnar
lateral/radial approach to elbow use?
radial head/ capitalu
Incision for lateral elbow?
Lat humerus to lat epicondyle, betwee ECRB and ECRL
What ligament is on the radial head?
annular lig
What neurovascular structures are at risk in the lateral approach to the elbow?
Anterior- posterior interosseus nerve
prox- radial nerve
medial approach to elbow use
ulnar nerve, medial epicondyle/coranoid #
nerve at risk in medial approach?
ulnar nerve
Henry’s forearm internervous plane?
prox- brachioradialis (radial) and pronator teres (median)
distally- brachioradialis (radial) and FCR (median)
What artery is beneath brachioradialis?
radial artery
What nerve splits at the intermuscular septum to a sensory and motor branch?
radial
posterior interosseous
superficial sensory
Which muscles can be released to access the anterior radial head?
pronator teres
FPL
Quadrator teres
Which muscles should you avoid releasing and why?
supinator
damage to PIN
Incision for carpal tunnel?
4th metacarpal
2-3 cm distal to palmar crease
use palmarus longus as a guide
Layers for carpal tunnel release?
skin, fat, ApoN of FLP, flexor retinaculum
What structure is medial to carpal tunnel?
ulnar nerve in Guyon’s canal
What variant can happen in the carpal tunnel?
Median nerve
Motor branch to the thumb coming off through flexor retinaculum
Carpal bones?
Scaphoid Lunate Triquentum Pisiform Trapezium Trapezioid Capitate Hamate
