upper limb anatomy Flashcards
What space does the axillary nerve pass through?
The quadrangular space
What nerves are at risk in an axillary node clearance?
The long thoracic nerve
Thoracodorsal nerve
Intercostobrachial nerve
Innervation to the abductor pollicis longus?
The ulnar nerve
What structure separates the ulnar artery from the median nerve?
Pronator teres - ulnar nerve lies deep to the pronator teres
How does the cephalic vein enter out of the upper arm?
It lies in the groove lateral to the biceps brachii.
What is the nerve supply to the mylohyoid?
Trigeminal
What nerve supplies all the hyoid muscles?
Ansa cervicalis
What is the innervation of the sternothyroid?
Ansa cervicalis
What is the innervation of the stylohyoid?
The facial nerve
What is the innervation to the digastric?
Anterior belly - trigeminal nerve
Posterior belly - facial nerve
How does the cephalic vein exit the arm?
It pierces the clavipectoral fascia and then goes deep through the deep deltopectoral triangle
How are the superficial veins of the arm separated from the brachial vessels?
Via the bicipital aponeurosis
When does the axillary artery start and end?
The axillary artery starts at the lateral border of the first rib and ends at the lower border of the teres major
What is the course of the radial artery?
Inferior to brachioradialis and superior to flexi carpi radialis
What is the course of the ulnar artery?
Lies on the flexor digitorum profundus overlapped by flexor carpi ulnaris. The median nerve lies on top.
Where does the suprascapular nerve come from and what does it innervate?
The upper trunk
Innervates supraspinatus and infraspinatus
What is the innervation of the teres minor?
Axillary nerve
What is the course of the axillary nerve?
The nerve originates from the lateral trunk of the brachial plexus and continues under the first rib.
Runs behind the axillary artery
Enters into the axilla via the quadrangular space. It then curves around the surgical neck of the humerus deep to the deltoid muscle.
What is the course of the radial nerve?
Lies behind the axillary artery and passes posteriorly between the hea of the trices in the spiral groove of the humerus. It pierces the intermuscular septum at the distal third of the humerus and enters the anterior compartment of the dorsla aspect of the arm.
What muscles does the radial artery lie between?
The brachialis and brachioradialis
From where is the musculocutaneous nerve derived?
The lateral cord of the brachial plexus. It pierces the coracobrachialis and runs between the biceps and brachialis.
From where is the median nerve derived?
Joining branches of the medial and lateral cord of the brachial plexus.
How does the median nerve lie in relation to the axillary and brachial artery?
Lies anterior to the distal third of the axillary artery, starts laterally to the brachial artery and becomes medial.
How does the median nerve enter the forearm?
Enters the forearm between the two heads of the pronator teres muscle.
Function of the anterior interosseous branch?
Innervates the deep muscles of the forearm including flexor pollicis longus, pronator quadratus and flexor digitorum profundus (lateral half)
From where is the ulnar nerve derived?
The medial cord of the plexus.
What is Erbs palsy caused by?
Downward traction on the arm during birth. C5, C6 roots affected.
Motor effects due to nerve palsy?
Paralysis of the deltoid, the supraspinatus, infraspinatus, brachialis, biceps. Waiters tip position.
What is Klumpkes palsy?
Claw hand which can be associated with Horners syndrome. It is due to traction of the sympathetic chain.
What occurs due to damage to the ulnar nerve at the elbow? (supracondular fracture of the humerus?
Loss of forearm pronation
Weakness of wrist flexion with ulnar deviation
Loss of senstation of the median nerve distribution
What are the borders of the anatomical snuffbox?
The abductor pollicis longus (lateral border)
The extensor pollicis longus medially with abductor pollicis brevis which lies on top.
What is the difference between the mid inguinal point and the mid point of the inguinal ligament?
Mid inguinal point: mid point between the ASIS and pubic symphsis.
Mid point of the inguinal ligament: The middle between the pubic tubercle and the ASIS.
What is McBurneys point?
It lies 2/3 between the umbilicus and ASIS.
What are the contents of the inguinal canal?
The spermatic cord in men, round ligament in women and the ilioinguinal nerve.
What is the location of the superficial inguinal ring?
Lies above and medial to the pubic tubercle.
What is the contents of the spermatic cord?
3 arteries - testicular artery, cremasteric artery, artery to vas
3 nerves - ilioinguinal nerve, genital nerve, sympathetics
3 layers of fascia - external oblique, cremasteric fascia, internal obliue.
3 other structures - vas deferens, lymphatics and pampiniform plexus
What is the origin and insertion of the psoas major?
The psoas major originates at T12-L5 and inserts into the lesser trochanter of the femur
What does the perineal pouch enclose?
The external urethral sphincter
What is contained within the deep perineal pouch?
bulbourethral (Cowpers glands) and deep transverse perineal muscle and muscles of the urethra.
Where do you find the superficial perineal pouch?
Superficial to the perineal membrane.
Why does ligation of the testicular artery not result in atrophy of the testicles?
Because the testicular artery anastomoses with the artery to vas from the spermatic cord.
What is the lymphatic drainage of the testicles and epididymis?
The para-aortic lymph nodes
What is the lymphatic drainage of the stomach?
The coeliac lymph nodes and the hepatic lymph nodes near the bile ducts sometimes which can cause obstructive symptoms in malignancy.
How do you identify the DJ flexure in surgery?
You identify the ligament of treitz which is a peritoneal fold that descneds from the right crus of the diaphgragm to the termination of the duodenum.
What is the blood supply to the duodenum and the head of the pancreas?
The superior and inferior pancreatoduodenal arteries.
Superior pancreatoduodenal arteries - a branch of the gastroduodenal arteries
- inferior pancreatoduodenal arteries - a branch of the the superior mesenteric artery
What are the peritoneal relations to the liver?
The liver is almost completely covered in peritoneum apart from the bare area at the back which is directly related to the IVC
What makes up the calots triangle?
The liver, cystic duct and common hepatic duct
What is the portal vein made from?
The hepatic vein and inferior mesenteric vein
Where do you find accessory spleens?
Tail of the pancreas, omentum and small bowel mesentery
What is the lymphatic drainage of the kidneys?
Para-aortic lymph nodes
What is the lymphatic drainage of the female reproductive system?
ovaries - para-aortic lymph nodes
uterine fundus - iliac lymph nodes
cervix - laterally is the eternal iliac nodes and posteriorly is the sacral lymph nodes.
along the uterine vessels is drained by the internal iliac lymph nodes
Lymphatic drainage of the vagina?
Upper 2/3 - internal iliac nodes
Lower 1/3 superficial inguinal lymph nodes
