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S1 - Morphology > UPPER LIMB > Flashcards

UPPER LIMB Flashcards

1
Q

MUSCULOSKELTAL SYSTEM

Arm: radiology

A
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2
Q

MUSCULOSKELETAL SYSTEM

Forearm: radiology

A
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3
Q

MUSCULOSKELETAL SYSTEM

Arm: radiology

A
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4
Q

MUSCULOSKELETAL SYSTEM

Muscles of upper limb

A
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5
Q

MUSCULOSKELETAL SYSTEM

Carpal Tunnel

A
  • fibro-osseous tunnel at ventral wrist
  • boundaries
    • anterior → flexor retinaculum
    • posteior → carpal bones (lunate)
  • components
    • 9 tendons (flexor digitorum superficial + flexor digitorum profundus + flexor pollicis longus)
    • radial + ulnar burses
    • median nerve (only)
    • no blood vessels
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6
Q

MUSCULOSKELETAL SYSTEM

Rotator Cuff

A
  • Muscles of glenohumeral joint (SITS)
    • supraspinatus
    • infraspinatus
    • teres minor
    • subscapularis
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7
Q

MUSCULOSKELETAL SYSTEM

Clinical Correlate: Carpal Tunnel Syndrome

A
  • condition that reducts space of carpal tunnel → compression of median nerve
  • symptons → median nerve
    • atrophy of tenar compartment + ape hand
    • sensory loss/numbness of lateral 3+1/2 digits
    • not lateral side of the palm (palmar cutaneous branch of the median nerve enters the hand superficial to the flexor retinaculum)
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8
Q

MUSCULOSKELETAL SYSTEM

Clinical Correlate: Humerous Head Dislocation

A
  • tipically occurs through inferior portion of the capsule
  • inferior portion → not reinforced by rotator cuff tendons
  • after inferior dislocation → humerous head is pulled superiorly and comes anterior to joint capsule
  • nerve injury
    • ​axillary
    • radial
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9
Q

MUSCULOSKELETAL SYSTEM

Clinical Correlate: rotator cuff lesions

A
  • rupture or tear of tendons
    • chronic use of the shoulder
    • fall with abducted upper limb
  • supraspinatus muscle → most frequently damaged
    • pain superiorly and anteriorly
    • glenohumeral joint abdcution pain
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10
Q

MUSCULOSKELETAL SYSTEM

Clinical Correlate: humeral fracture

A
  • Surgical Neck
    • axillary nerve damaged
    • posterior humeral circumflex artery
  • Mid-Shaft
    • radial groove fracture
    • radial nerve
    • profunda brachii artery
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11
Q

MUSCULOSKELETAL SYSTEM

Clinical Correlate: carpal bones fracture

A
  • Scaphoid
    • most frequently fractured
    • separation of proximal head of the scaphoid
    • avascular necrosis of the proximal head
  • Lunate
    • most commonly dislocated
    • anterior dislocation
    • compression of median nerve (carpal tunnel syndrome)
  • Hamate
    • fall of outstretched hand
    • fracture the hook of the hamate
    • ulnar nerve lesion
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12
Q

NERVE SUPPLY

Brachial Plexus: roots

(5)

A

C5 - T1

+

long thoracic nerve

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13
Q

NERVE SUPPLY

Brachial Plexus: trunks

(3)

A

Superior

C5 + C6

supraescapular nerve

Middle

C7

Inferior

C8 + T1

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14
Q

NERVE SUPPLY

Brachial Plexus: divisions

(2)

A

Anterior

musculocutaneus + median + ulnar

Posterior

radial + axillary

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15
Q

NERVE SUPPLY

Brachial Plexus: cords

(3)

A

Lateral

anterior division → superior + middle trunks

Medial

anterior division → inferior trunk

Posterior

posterior division → all trunks

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16
Q

NERVE SUPPLY

Brachial Plexus: terminal branches

(5)

A
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17
Q

NERVE SUPPLY

Motor innervation: musculocutaneus nerve

A
  • C5 - C6
  • anterior compartment of arm
  • flex elbow + supination (biceps brachii)
18
Q

NERVE SUPPLY

Motor innervation: median nerve

A
  • C5 - T1
  • forearm → anterior compartment
    • except flexor carpi ulnaris + ulnar half of flexor digitorum profundus
    • flex wrist + all digits
    • pronation
  • hand
    • thenar compartment → opposition thumb
    • central compartment → lumbricals of digits 2 and 3 (flex metacarpophalangeal + interphalangeal)
19
Q

NERVE SUPPLY

Motor innervation: Ulnar nerve

A
  • C8 - T1
  • Forearm → anterior compartment
    • except muscles innervated by median
    • flex wrist (weak) + digits 4 and 5
  • Hand
    • hypotenar compartment
    • interossei palmar (adduct digits 2-5)
    • interossei dorsal (abduct digits 2-5)
    • lumbricals (flex metacarpophalangeal and interphalangeal digits 4 and 5)
    • adductor pollicis (adduct thumb)
20
Q

NERVE SUPPLY

Motor innervation: radial nerve

A
  • C5 - T1
  • Posterior compartment
    • arm → extend elbow
    • forearm → extend wrist + digitals + supination
21
Q

NERVE SUPPLY

Motor innervation: axillary nerve

A
  • C5-C6
  • deltoid → abduct shoulder (15-110º)
  • teres minor → lateral rotation shoulder
22
Q

NERVE SUPPLY

Motor innervation: segmental innervation

A

proximal-distal gradient

  • shoulder → C5-C6
  • distal arm + proximal forearm → C6 - C7
  • hand → C8 + T1
23
Q

NERVE SUPPLY

Sensory Innervation: shoulder and arm

A
24
Q

NERVE SUPPLY

Sensory Innervation: hand and forearm

A
25
Q

NERVE SUPPLY

Collateral Nerves: Brachial Plexus

A
  • Long Thoracic Nerve (C5,C6,C7 roots)
  • Dorsal Scapular Nerve (C5 root)
  • Nerve to subclavius (superior trunk)
  • Suprascapular Nerve (anterior division of superior trunk)
  • Upper and Lower Subscapular Nerves (posterior cord)
  • Thoracodorsal Nerve (posterior cord)
  • Medial brachial and forebrachial Cutaneous Nerve (medial cord)
  • Medial Pectoral Nerve (medial cord)
  • Lateral Pectoral Nerve (lateral cord)
26
Q

NERVE SUPPLY

Collateral Nerves

A
27
Q

NERVE SUPPLY

Clinical Correlate: Upper Brachial Plexus Lesion

A
  • C5 - C6 → axillary + suprascapular + musculocutaneus
  • Erb-Duchenne Palsy - “waiter’s tip syndrome”
  • head-shoulder forcibly separation - accident + birth injury + herniation
  • motor
    • shoulder: medial rotation + adduction (axillary and suprascapular loss + pectolis major and latissimus dorsi compensation)
    • forearm: extention + pronation (musculocutaneus loss)
  • sensory
    • musculocutaneus
    • lateral forearm to base of thumb
28
Q

NERVE SUPPLY

Clinical Correlate: Lower Brachial Plexus Lesion

A
  • C8 - T1 → ulnar + median (hand)
  • Klumpke’s Paralysis
  • upper limb forcefullly abducted above the head → birth injury, thoracic outlet syndrome and grabbing an object when falling
  • motor
    • claw hand (ulnar) + ape hand (median)
    • horner syndrome in some cases
  • sensory → ulnar territory
29
Q

NERVE SUPPLY

Clinical Correlate: In lesions of branches of the brachial plexus, motor weakness precedes sensory loss

True or False

A

FALSE

sensory loss precedes motor weakness

30
Q

NERVE SUPPLY

Clinical Correlate: In lesions of branches of the brachial plexus, proximal lesions have more signs

True or False

A

TRUE

31
Q

NERVE SUPPLY

Clinical Correlate: Radial Nerve

A
  • Axilla → saturday night palsy
    • motor loss: extension (arm, wrist and digits) + supination
    • sensory loss: posterior (arm, forearm, thumb)
    • wrist drop
  • Elbow → lateral epicondyle // radio head
    • motor loss: extension (not elbow, wrist and digits) + supination
    • sensory loss: posterior (forearm and thumb)
    • wrist drop
  • Wrist → laceration
    • no motor loss
    • sensory loss: dorsal thumb
32
Q

NERVE SUPPLY

Clinical Correlate: Median nerve

A
  • Elbow → supracondilar fracture (humerus)
    • motor loss: flexion (ulnar deviation) + pronation + digital flexion (3 lateral digits) + thumb opposition + thenar atrophy
    • sensory loss: lateral hand + palmar surface of lateral 3 + 1/2 digits
    • ape hand (thumb opposition) + hand of benediction (digital flexion)
  • Wrist → carpa tunnel // laceration
    • motor loss: thumb opposition + thenar atrophy
    • sensory loss: palmar surface of lateral 3 + 1/2 digits
    • only ape hand (thumb opposition)
33
Q

NERVE SUPPLY

Clinical Correlate: Ulnar nerve

A
  • Causes
    • elbow (medial epicondyle)
    • wrist (laceration)
    • fracture of hook of hamate
  • Motor loss
    • loss → abdution/adduction digits 2-5 (interossei) + thumb adduction + hypothenar atrophy
    • weaknig → interphalangeal 2-5 digits extension + wrist flexion (radial deviation)
  • Sensory loss → ulnar territory
  • Claw hand
34
Q

NERVE SUPPLY

Clinical Correlate: Axillary nerve

A
  • Causes
    • surgical neck of humerus fracture
    • inferior dislocation of shoulder
  • Motor loss → abduction of arm
  • Sensory loss → skin over deltoid muscle
35
Q

NERVE SUPPLY

Clinical Correlate: Musculocutaneus nerve

A
  • Motor → loss of elbow flexion + weakness in supination
  • Sensory → lateral forearm
36
Q

NERVE SUPPLY

Clinical Correlate: Long Thoracic nerve

A
  • Causes → superficial surface of serratus anterior muscle
    • radical mastectomy
    • stab in lateral chest
  • Winged Scapula
  • Abduction of the arm
37
Q

NERVE SUPPLY

Clinical Correlate: Suprascapular nerve

A

SHOULDER

Loss of abduction 0-15º

(suprascapular muscle)

+

Weakness of lateral rotation

(infraspinatus muscle)

38
Q

VASCULAR SYSTEM

Arterial Supply

A
39
Q

VASCULAR SYSTEM

Venous Supply

A
40
Q

VASCULAR SYSTEM

Lymphatic System

A
41
Q

VASCULAR SYSTEM

Clinical Correlate: axillary lymph nodes

A
  • Groups
    • anterior (pectoral) - breast
    • posterior (subscapular) - back
    • lateral - upper limb (profund)
    • central - from the three above
    • infraclavicular (deltopectoral) - upper limb (superficial)
    • apical - from all the other axillaty nodes
  • Importance: breast cancer + metastasis
42
Q

VASCULAR SYSTEM

Clinical Correlate: axillary artery branches

A

HoTeL-SPA

  1. (Highest) Superior Thoracic
  2. Thoracoacromial
  3. Lateral Thoracic
  4. Subscapular
  5. Anterior Circumflex Humeral
  6. Posterior Circumflex Humeral

S1 - Morphology (10 decks)

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