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Lower Limb > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

Clavipectoral fascia borders

A

Superior = clavicle (continue superior to clavicle to become the investing layer of deep cervical fascia)

Inferior = axillary fascia

Medial = membrane of 1st / 2nd ext IC

Lateral = coracoid process / coracoclavicular lig

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2
Q

Structures enclosed by clavipectoral fascia

A
  1. Subclavius

2. Pec minor

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3
Q

Structures perforating clavipectoral fascia

A
  1. Thoraco-acromial A
  2. Cephalic V
  3. Lateral pectoral N
  4. Lymphatics from anterior breast (to apical node)
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4
Q

Costocoracoid lig

A

@ lower border of subclavius x2 layers of clavipectoral fascia fuse to form a well-developed band

Stretches from the coracoid process to the 1st rib (costochondral junction)

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5
Q

Main stabilising factor of the SCJ

A

Costoclavicular lig

Binds the clavicle to the 1st CC + the adjacent end of the 1st rib just lateral to the joint

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6
Q

Main stabilising factor of the ACJ

A

Coracoclavicular lig

x2 parts - trapezoid, conoid
~4cm from the ACJ + give it vertical stability

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7
Q

Coracoid-clavicular distance

A

Otherwise known as CC distance

<12mm

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8
Q

Borders of axilla

A

Medial - serratus ant (slips 1-4)

Lateral - bicipital groove / LH of biceps tendon

Anterior - CP fascia / pec minor / pec major

Posterior - subscap / teres major / lat dorsi tendon

Roof - bound by:

  1. Scapula (posterior)
  2. Outer border of 1st rib (medial)
  3. Clavicle (anterior)

Floor - axillary fascia (supported by suspensory lig)

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9
Q

Contents of axilla

A
  1. Cords of brachial plexus
  2. Long thoracic N
  3. Axillary A + V
  4. LNs
  5. LH of biceps
  6. Tendon of lat dorsi
  7. Teres major
  8. Pec minor / CP fascia
  9. Coracobrachialis
  10. Short head of biceps
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10
Q

Br of axillary A

A

“Screw The Lawyer Save A Patient”

1st part x1 / 2nd part x2 / 3rd part x3

  1. Superior thoracic A - 1st part
  2. Thoracoacromial A - 2nd part
  3. Lateral thoracic A - 2nd part
  4. Subscapular A - 3rd part
  5. Ant humeral Cx A - 3rd part
  6. Post humeral Cx A - 3rd part
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11
Q

Axillary sheath

A

Covers the axillary A NOT the axillary V

Continuation of prevertebral fascia from the neck

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12
Q

Subscap A

A

4th br of axillary A (arises from 3rd part)

Runs along posterior wall of the axilla giving off Cx scapular A

Cx scapular A passes between subscap / TM (medial to LH of triceps + thus, medial to quad space)

After br CSA the subscap A becomes the thoracodorsal A + supplies lat dorsi

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13
Q

Cx Humeral A

A

Post:

  • Larger br
  • Passes through quad space w/ axillary N
  • Anastomoses w/ ant br + profunda brachii A
Ant: 
- Smaller br
- Passes deep to coracobrachialis + x2 heads of biceps 
  around the surgical NOH
- Anastomoses w/ post br
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14
Q

Comparison of scapula winging

A

Lateral scapula winging

  • Trapezius weakness
  • Spinal accessory N (CN XI)

Medial scapula winging

  • Serratus ant
  • Long thoracic N (C5 / C6 / C7)
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15
Q

Dangers of lat approach to shoulder J

A

Lateral incision w/ splitting of deltoid

Incision should be no longer than 5cm from the acromion to avoid inj to the axillary N

Axillary N circles the humeral head ~7cm inferior to the acromion

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16
Q

Path of Axillary N

A

Passes through quadrangular space + circumflexes the head of the humerus ~7cm below the acromion

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17
Q

Scapular anastomosis

A
  1. Dorsal scapular A (via transverse cervical A)
  2. Suprascapular A
  3. Subscapular A, which gives off:
    1. Cx humeral A
    2. Thoracodorsal A
18
Q

Spaces assoc. w/ Teres major

A
  1. Quadrangular space - axillary N + post Cx humeral A
  2. Triangular interval - radial N + profunda brachii A
  3. Triangular space - Cx scapular A
19
Q

Borders of quadrangular space

A

Medial = LH of triceps

Lateral = SNOH

Superior = Teres minor

Inferior = Teres major

20
Q

Borders of triangular interval

A

Base = Teres minor

Medial = LH of triceps

Lateral = humeral shaft

21
Q

Triangular space

A

Lateral (base) = LH of triceps

Superior = Teres minor

Inferior = Teres major

22
Q

Stability of the shoulder

A
  1. RC muscles + fusion of tendons w/ capsule
  2. Coracoacromial arch (overhanging coracoid / CA lig / acromion process)
  3. Glenoid labrum
  4. Muscles attached from pec girdle to humerus
    • Esp. LH biceps / LH triceps
23
Q

Anatomical relations of biceps aponeurosis

A

Passes medially from insertion of biceps onto radial tuberosity to insert into deep fascia of the forearm flexors

Brachial A + median N pass deep to bicipital aponeurosis + medial to radial tubersity

Medial cubital V passes superficial to the biceps aponeurosis

24
Q

Musculocutaneous N in the arm

A

Runs underneath biceps muscle + above brachial

Terminal branch is the lateral cut N of forearm, which runs between the brachialis + biceps to reach its endpoint

25
Q

C4 / C5 disc herniation

A

Weakness with elbow flexion + supination (i.e. biceps muscle)

Reduced sensation in lateral aspect of arm (lateral aspect of forearm is C6)

Loss of biceps tendon reflex (C4 / C5, but predominantly C5)

26
Q

Structure @ risk w/ anterior appr to shoulder J

A

Musculocutaneous N, which pierces the coracobrachialis 3-8cm distal to the coracoid process

27
Q

Only muscle in the anterior arm compartment w/ dual nerve supply?

A

Brachialis

Supplied by:

  1. Musculocutaneous N (pre-dominant)
  2. Radial N (small area of lateral aspect of muscle)
28
Q

Important relations of brachioradialis

A

@ distal humerus the radial N lies between brachioradialis (deep) + brachial (superficial)

Superficial sensory br of radial N runs distally in the forearm under the cover of brachioradialis, lateral to the radial A

29
Q

Surg appr to humerus

A

Long anterior curved incision

Medialise the biceps w/ retraction

Divide the brachialis muscle centrally

30
Q

Surg appr distal humerus

A

Oblique incision between brachialis + brachioradialis

Medialise biceps + brachialis w/ retraction

Lateralise brachioradialis w/ retraction

Need to identify radial N, which lies immediately deep to brachioradialis

31
Q

Radial N passes through…

A

Lateral + medial heads of triceps in the radial groove

32
Q

Median N passes through…

A

x2 heads of pronator teres

33
Q

Ulnar N passes through

A

x2 heads of FCU

34
Q

Medial IM septum of arm

A

Arises from medial supracondylar ridge behind CB + fades out above - between CB + LH of triceps

Pierced by ulnar N + ulnar collateral A

35
Q

Lateral IM septum of arm

A

Arises from lateral supracondular ridge

Between triceps (posterior) + ECRL / BR (anterior)

Pierced by radial N + ant descending br of profunda brachii A

36
Q

Relationship of pronator teres to NV structures

A

Median N passes between the CFO / ulnar heads of pronator teres

Ulnar head separates the median N + ulnar A from each other

  1. Median N runs superficial to the ulnar head
  2. Ulnar A runs deep to the ulnar head
37
Q

Parona’s space

A

Potential space in volar wrist between PQ + FDP

Facilitates communication between the radial + ulnar bursae from the fingers

Space can act as a conduit for the spread of a hand infection

38
Q

Borders of Parona’s space

A

Dorsal = PQ

Volar = FDP

Ulnar = FCU

Radial = FPL

39
Q

FCR / PL / Median N relationship

A

FCR is medial + PL is lateral to the median N

Deep lac to FCR may result in median N inj

Palm cut br of median N arises between PL + FCR + is @ risk w/ carpal tunnel incision or Henry (volar) appr to DR

40
Q

Lumbrical plus finger

A

= paradoxical extension of finger when trying to flex the finger

Due to disruption of FDP distal to the insertion of the lumbricals into the dorsal expansion

Lower Limb (2 decks)

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