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GSSE Anatomy > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

What is the embryological basis for limb nerve supply?

A
  • limb buds grow from lateral strip supplied by lateral branches of anterior rami
  • plexuses formed by anterior and posterior divisions to supply muscles and skin
  • posterior: extensor muscles and skin
  • anterior: flexor muscles and skin
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2
Q

What are the markers of the preaxial and postaxial border in the upper limb?

A

preaxial: cephalic
postaxial: basilic

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3
Q

What is an example of a flexor muscle supplied by an extensor compartment nerve? Why is this?

A
  • lateral portion of brachialis (radial nerve)
  • muscle develops in extensor compartment of fetal limb, but is in flexor compartment functionally as adult so brings its nerve supply with it
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4
Q

Describe the course of the anterior axillary line and posterior axillary line.

A

p 30 fig 1.16
sternal angle to 2nd costal cartilage, down front of limb to wrist

from vertebra prominens to insertion of deltoid muscle

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5
Q

Where are the origins/insertions of pectoralis major?

A
  • clavicular head: medial half of anterior clavicle
  • sternocostal head: lateral part of anterior sternum/manubrium/external oblique, upper attachment of rectus abdominis, upper 6 costal cartilages
  • insert: trilaminar into bicipital groove fig 2.1
    note lowermost fibres of sternocostal origin twist upwards deep to manubrial fibres
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6
Q

What is the nerve supply and best way to test pectoralis major?

A

p. 70
NS: medial and lateral pectoral nerves (from medial and lateral cords)
only muscle of upper limb to be supplied by all 5 segments of brachial plexus
- C5,6 clavicular head
- C7, 8 T1 sternocostal part

TEST

  • abduct arm to 90 degree and push forward against resistance
  • abduct to 60 degrees and adduct against resistance
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7
Q

What is the origin and insertion of pectoralis minor?

What is its relation to the axillary artery and cords of the brachial plexus?

A
  • arises from 3rd, 4th, 5th ribs (not costal cartilage)
  • inserts into medial border and upper surface of coracoid process

UNDERNEATH:

  • divides axillary artery
  • cords of brachial plexus deep
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8
Q

What are the 3 parts of the axillary artery and its relations at each stage to elements of the brachial plexus? What are the relevant surface markings?

A

1st (above pec minor):
2nd (behind pec minor): part clasped by 3 cords of plexus
3rd (below pec minor): clasped by 2 heads of median nerve in anatomical position

SURFACE MARKINGS
- curved line from middle of clavicle, below coracoid process to groove behind coracobrachialis

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9
Q

What is the nerve supply and action of pectoralis minor?

A

NS: pectoral nerves (C6, 7, 8) (medial and lateral)

assists in protraction of scapula

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10
Q

What are the boundaries of the clavipectoral fascia?
What structures does it enclose?
What structures pierce it?

A

fig 2.3

  • superiorly from the clavicle (not physically continuous above with investing layer of deep cervical fascia)
  • medially from the costochondral joints
  • superolaterally from the coracoid process.
  • turns into suspensory ligament of axilla below pec minor
    https: //www.earthslab.com/wp-content/uploads/2017/06/060717_0233_FasciaePact1.jpg

CONTENTS

  • subclavius
  • pec minor
  • ribs

CALL : pierces above pec minor

  • Cephalic vein
  • thoracoAcromial artery
  • Lateral pectoral nerve
  • Lymphatics
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11
Q

What are the branches of the axillary artery?

A

1st part: 1
- superior thoracic artery

2nd part :2

  • lateral thoracic
  • thoracoacromial

3rd part: 3

  • subscapular
  • anterior circumflex humeral
  • posterior circumflex humeral
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12
Q

What are the boundaries of the axilla?

A

FLOOR: axillary fascia
ANTERIOR: pec maj, pec min, subclavius, clavipectoral fascia
POSTERIOR: subscapularis and teries major
MEDIAL: serratus anterior

LATERAL LIMIT: intertubercular groove
LOWER LIMIT: 4th rib

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13
Q

What are the muscles of the hand that ARE NOT supplied by the ulnar nerve

A

hand muscles not supplied by ulnar nerve

MEAT : median

L: laterral two lumbricals
O: opponens pollicis
A: abductor pollicis brevis
F: flexor pollicis brevis

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14
Q

Structures that are in flexor retinaculum

A
  • tendons of flexor dig sup/prof
  • median nerve
  • tendon of flexor pollicis longus
  • flexor carpi radialis tendon
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15
Q

Structures that escape the flexor retinaculum.

A
  • ulnar artery
  • ulnar nerve
  • palmar cutaneous branch median nerve
  • palmaris longus
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16
Q

What are the attachments of the flexor retinaculum?

A

scaphoid
hook of hamate
trapezium
piseform

17
Q

What are the branches of the brachial plexus from the roots?

A

C5
- Dorsal scapular nerve

C5, C6
Nerve to subclavius

C5, C6, C7
- Long thoracic nerve

18
Q

What is the branch of the brachial plexus that exits from the trunks?

A

Suprascapular nerve exits from upper trunk in the posterior triangle of the neck(C5,C6)

19
Q

What are the branches from the divisions of the brachial plexus?

A

there are NO branches associated with the divisions

20
Q

What are our branches off the cords?

A

LATERAL (LML)

  • lateral pectoral nerve
  • Musculocutaneous nerve
  • Lateral root of median nerve

MEDIAL (M4U)

  • medial pectoral nerve
  • medial cutaneous nerve of arm and forearm
  • medial cord of median nerve
  • ulnar nerve

POSTERIOR (ULTRA)

  • upper and lower subscapular nerves
  • thoracodorsal nerve
  • radial nerve
  • axillary nerve
21
Q

What are the terminal branches of the brachial plexus?

A

POSTERIOR

  • axillary
  • radial

LATERAL

  • musculocutaneous nerve
  • median

MEDIAL

  • ulnar
  • median
22
Q

What is the most common traction injury to the brachial plexus?

A

Erb’s palsy?

  • C5, C6 injury
  • arm is medially rotated, extended at elbow
  • loss of sensation on lateral side of arm and forearm
23
Q

What is Klumpke’s paralysis? How is it sustained?

A
  • Damage to C8 T1
  • birth inury with arm remaining above head during breech
  • leads to claw hand with inability to extendfingers, ulnar sensory loss and potentially horner’s syndrome
24
Q

How to test for radial nerve injury? High vs low?

A
  • wrist drop
  • interphalangeal joints will still be straightened by action of interossei and lumbricals
  • sensory loss over 1st dorsal interosseous space
  • HIGH INJURY: elbow extension (branch to triceps arises before nerve reaches humerus)
  • LOW INJURY: extension of wrist
25
Q

What is the ulnar paradox?

A

Injury at elbow or above give STRAIGHTER fingers because you lose the ulnar half of FDP, forcing the 4th and 5th fingers into extension

Injury below elbow gives MORE FIXED FLEXION due to the preservation of FDP

‘the closer to the Paw, the worse the Claw’.

26
Q

What are the distinguishing features of a median nerve injury?

A
  • sensory loss over radial 3 fingers and radial palm
  • HIGH: wasting of front of forearm
  • LOW: test abductor pollicis brevis
  • pointed finger fixed extension
27
Q

What is the quadrangular (quadrilateral) space?

A
  • from posterior, teres minor
  • from anterior, teres major
  • subscapularis is superior border
  • bounded laterally by humerus, medially by long head of triceps

TRANSMITS

  • axillary nerve
  • posterior circumflex humeral artery
  • posterior circumflex humeral vein

p. 82

28
Q

What are the branches of the axillary artery?

A

SOME TIMES LIFE SEEMS A PAIN

1st part = 1
- superior thoracic artery (to both pecs)

2nd part = 2

  • thoracacromial artery
  • lateral thoracic artery

3rd part = 3

  • subscapular (thoracodorsal)
  • anterior circumflex humeral
  • posterior circumflex humeral
29
Q

Where are the short and long tendons of biceps inserted?

A

LONG: supraglenoid tubercle and adjoining glenoid labrum
SHORT: apex of coracoid process lateral to coracobrachialis

30
Q

Which muscles attach to the greater and lesser tuberosity respectively?

A

GREATER

  • supraspinatus
  • infraspintaus
  • teres minor

LESSER

  • subscapularis
  • teres major
31
Q

What is the surface marking of the radiocarpal joint?

A

Fig 2.60
Proximal skin crease of the wrist
https://scontent.xx.fbcdn.net/v/t1.15752-0/p280x280/119486923_1296130657395670_6004529273095750123_n.png?_nc_cat=110&_nc_sid=b96e70&_nc_ohc=ks75n2J_UPsAX9FReTQ&_nc_ad=z-m&_nc_cid=0&_nc_ht=scontent.xx&oh=48e6cca0e2f1d4057c8a639602b28a6d&oe=5F848976

32
Q

Which muscles of the forearm are supplied by radial before radial becomes posterior interosseous nerve.

A

brachioradialis
brachialis (additional supply, not main)
extensor carpi radialis longus

p 160 Lasts

GSSE Anatomy (7 decks)

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