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OSPE > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

Identify on a skeleton – clavicle, scapula (acromion and scapular spine), humerus, radius/ulna,
carpal bones, metacarpals, phalanges

A

Netters

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2
Q

Testing Joints and their Movements (list the joints and their corresponding movements)

A

Scapulo-thoracic – protraction, retraction, elevation, depression
Shoulder joint - flexion, extension, abduction, adduction, circumduction
Elbow joint – flexion, extension,
Proximal and distal radio-ulnar joints - pronation, supination
Wrist joint- flexion, extension, ulnar and radial deviation
Carpo-metacarpal joints of thumb and other digits
Metacarpo-phalangeal and interphalangeal joints

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3
Q

How is the extrinsic shoulder muscle group tested?

+ nerve supply

A

Trapezius - raise both shoulders against resistance (acessory)

SCM - turn head left/right against resistance (accessory)

Serratus anterior - both arms outstretched with the palms against a wall, ask the patient to press forward strongly (long thoracic C56)

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4
Q

How are the pectoral muscles tested?

A

Pec major and minor - adduct the arm against resistance, from an abducted position (lateral and medial pectoral c5-t1)

Teres major - adduct the arm against resistance (see and palpate in the posterior axillary fold)

Lat dorsi - adduct the aarm to 90 degrees, and then adduct against resistance. See and palpate in the posterior axillary fold

Teres major lower subscapular nerve (C5-6)

Lat dorsi thoracodorsal nerve (C6-8)

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5
Q

How is the deltoid muscle tested?

A

Abduct the upper arm against resistance (axillary C5-6)

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6
Q

How are the intrinsic shoulder muscles tested?

A

Supraspinatus - abduct the arm against resistance (first 15 degrees)

  • Subscapularis - internal rotation
  • Infraspinatus and teres minor - external rotation

Suprascapular nerve C5-6 supplies the supraspinatus and infraspinatus

Upper and lower subscapular C5-6 supplies subscapularis

Axillary nerve supplies the teres minor

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7
Q

How are the flexors and extensors at the elbow tested?

A
  • Biceps brachii - flex forearm against resistance (musculocutaneous nerve C5-7)
  • Triceps brachii - extend flexed forearm against resistance (radial C6-8)
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8
Q

How are the pronators and supinators tested?

A

Pronate against resistance - Pronator teres/quadratus – median nerve (C5,6,8T1)

Supinate against resistance – supinator – radial nerve (C5,6,7,8,T1)

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9
Q

How are the superficial wrist flexors of the forearm tested?

A

FCR, FCU, PL, APL – Flex wrist against resistance – Median, ulnar

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10
Q

How are the deep digital flexors of the forearm tested?

A

FDS – Flex finger at prox. Interphalangeal joint against resistance – median nerve (C5,6,8,T1)

FDP – flex distal interphalangeal joints against resistance – median nerve + ulnar(C5,6,8,T1)

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11
Q

How are the extensors in the wrist and digits in the forearm tested?

A

ECRL – radial deviation against resistance – radial nerve (C5,6,7,8,T1)

ECRB – ulnar deviation against resistance – radial nerve (C5,6,7,8,T1)

ED – Extend MCP (digits 2-5) against resistance – posterior interosseous

EDM – extend little finger against resistance (all joints) – posterior interosseous

ECU – extend wrist against resistance – radial nerve (C7,8)

APL – abduct thumb against resistance – posterior interosseous

EPB – extend thumb against resistance (IP joint) – posterior interosseous

EPL - extend thumb against resistance (MCP joint) – posterior interosseous

EI – Extend index finger against resistance - posterior interosseous

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12
Q

How are the thenar and hypothenar muscles tested?

A

Thenar
APB – abduct thumb against resistance – median nerve

FPB – flexes thumb against resistance – median nerve

OP – oppose thumb against resistance – median nerve

Hypothenar
ADM – Abduct little finger against resistance – ulnar nerve

FDMB – Flex little finger at MCP against resistance – ulnar nerve

ODM – flex little finger against resistance

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13
Q

How are the interossei tested?

A

Dorsal IO – abduct 3 middle fingers - ulnar

Palmar IO – adducts fingers - ulna

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14
Q

Demonstrate palpation of arterial pulses in the upper limb and describe rate- subclavian, axillary,
brachial in the arm, brachial in cubital fossa, ulnar and radial at the wrist. The bones, against which
these pulse palpations occur should, be recognised.

A

Subclavian – posterior side of clavicle, medially – clavicle

Axillary – in axilla – humerus

Brachial (arm) – medial side of middle 3rd of humerus. Medial to biceps – humerus

Brachial (cubital fossa) – medial side in cubital fossa – ulna

Ulnar – between the two tendons in wrist – ulna

Radial – radial side, under wrist - radius

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15
Q

Veins – surface mark basilic, cephalic, median cubital veins

A

Basilic – medial side of dorsal venous network of hand to elbow. Branches to give off median cubital vein, medial side of biceps, joins brachial veins in axilla to form axillary vein

Cephalic – Lateral side of forearm, connects with basilic via median cubital vein. Up lateral side of arm. Empties into axillary vein after deltoid

Median cubital – in cubital fossa, connects basilic to cephalic

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16
Q

Map the dermatomes of the upper limb C5 – T1, T2

A

C4 - Shoulder

C5 – lateral arm

C6 – Lateral forearm and thumb

C7 – Middle finger

C8 – Medial hand, forearm and little finger

T1 – Medial side of upper arm and forearm

T2 - Axilla

17
Q

Test deep tendon reflexes – biceps and triceps using tendon hammers and recall
nerve roots

A

Biceps reflex – forearm semi extended, flex to palpate biceps tendon, place thumb over biceps tendon, tap thumb with tendon hammer (pendulum motion) (C5,6)

Triceps reflex – Arm upside down, flexed at 90°. Palpate triceps tendon, tap directly with tendon hammer (C7,8)

18
Q

Test motor and sensory components of axillary nerve

A

C5-6
M: abduct shoulder against resistance >15°, external rotation of the arm (supplies deltoid and teres minor).

S: regimental patch (superior lateral cutaneous nerve). Damage in humeral surgical neck break.

19
Q

Test motor and sensory components of the musculocutaneous nerve

A

C5-7

M: Coracobrachialis, biceps brachii and brachialis supplied (BB, Br), therefore flex the arm and flex the shoulder when the elbow is flexed (CB)

S: lateral sensation of forearm by lateral antebrachial cutaneous nerve

20
Q

Test motor and sensory components of the radial nerve (proximal)

A

C5-T1

M: brachialis, triceps brachii/aconeus and brachioradialis, external carpi radialis longus and brevis - extend the arm and extend the wrist

S: Inferior lateral brachial cutaneous nerve and posterior lateral brachial cutaneous nerve - test the lateral and posterior sensation of the arm

21
Q

Test motor and sensory function of distal radius

A

C5-T1

M: supinator, ECY, ED, EDM, EPL, EPB, EI - extend fingers at MCP joint

S: Test posterior sensation of the forearm and hand (posterior antebrachial cutaneous nerve, superficial branch and dorsal digital branches)

22
Q

Test motor and sensory function of ulnar nerve

A

C8-T1

M: Hypothenar, lumbricals 3-4, interossei, adductor policis and flexor pollicis brevis - abduct/adduct fingers, oppose the pinky (also supplies medial half of FDP and FCU)

S: Lateral half of the hand - test pinky palmar sensation

23
Q

Test motor and sensory function of proximal median nerve

A

C5-6, C8-T1

M: Pronator teres, FCR, palmaris longus, flexor digitorum superficialis - attempt to pronate forearm, flex the wrist and fingers

S: None

24
Q

Test motor and sensory function of the anterior interosseus of median nerve

A

M: FPL, FDP, Pronator quadratus (attempt to supinate the forearm, flex the thumb)

S: None

25
Q

Test motor and sensory function of the distal median nerve

A

C5-6, C8-T1

M: Abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, lateral 2 lumbricals - abduct and oppose the thumb, abduct/adduct lateral fingers

S: Palmar branch and palmar digital branches - test sensation of lateral palm

26
Q

When is musculocutaneous nerve commonly damaged?

A

Shoulder dislocation

27
Q

What is the result of radial nerve damage?

A
  • Cant extend the elbow if proximally

- Wrist drop if distal

28
Q

What is the result of damage to the ulnar nerve?

A
  • Cut at wrist, clawing hands.

- Cut further up, less severe clawing (as damages the ulnar part of the flexor digitorum profundus)

29
Q

When is median nerve commonly damaged?

A

Carpal tunnel syndrome

30
Q

Identify boundaries of the axilla

A
  • The base is composed of skin, subcutaneous tissue and fascia extending from the arm to the chest
  • The apex lies between the first rib, the clavicle and the superior border of the subscapularis muscle
  • The anterior wall is formed by pectoralis major and pectoralis minor
  • The posterior wall is formed by the scapula and subscapularis (superiorly) and the teres major and latissimus dorsi (inferiorly)
  • The medial wall is formed by the chest wall (1st to 4th ribs) and the serratus anterior
  • The lateral wall is formed by the intertubercular groove of the humerus
31
Q

Identify the boundaries of the cubital fossa

A

Sup. – line between epicondyles

Med. – pronator teres

Lat. – brachioradialix

32
Q

Demonstrate boundaries of anatomical snuff box and what it is used for

A

Med. – EPL tendon

Lat. – APL and EPB tendon

Prox. – Styloid process

Floor. – Scaphoid and trapezium

Used to feel broken scaphoid, radial artery runs on floor

33
Q

Describe the position of the flexor retinaculum

A
  • Hook of hamate
  • Pisiform
  • Tubercle of scaphoid
  • Ridge of trapezium
34
Q

How is the brachioradialis muscle tested?

A

Flex the elbow against resistance with the forearm in midprone position (radial nerve)

35
Q

Compare erbs lesion and klumpke’s lesion

A
  • Erb affects upper nerve roots (arm will be pronated, elbow extended, wrist flexed)
  • Klumpke affects lower nerve roots (true claw)

OSPE (6 decks)

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