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MRCS B > Upper Limb Anatomy > Flashcards

Upper Limb Anatomy Flashcards

1
Q

Where are the roots of the brachial plexus found

A

Between scalenus anterior and medius

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2
Q

Where are the trunks of the brachial plexus found

A

Base of the posterior triangle of the neck behind 3rd part of subclavian artery

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3
Q

Where are the divisions of the brachial plexus found

A

Behind the middle 1/3 of the clavicle

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4
Q

Where are the cords of the brachial plexus found

A

Related to the 2nd part of axillary artery

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5
Q

What is Erb’s palsy

A

Damage to roots C5 and C6
Waiters tip deformity - arm adduction, arm internal rotation, forearm extension and pronation, wrist flexion.
Loss of sensation of the radial side of arm and forearm

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6
Q

What is Klumpe’s palsy

A

Injury to lower cords - C8 and T1
Claw hand deformity - muscle wasting and loss of fine finger movements, weak wrist and finger flexion, hyperextension of MCPJ, flexion of PIPJ
Loss of sensation over ulnar aspect of forearm and hand

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7
Q

In Erb’s palsy which reflexes are impacted

A

Biceps and brachioradialis reflexes

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8
Q

Show the roots of the brachial plexus

A
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9
Q

What is the action of brachioradialis

A

Relatively weak flexion of the forearm which is maximal when forearm is in midpronated position

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10
Q

What muscles are supplied by the musculocutaneous nerve

A

Biceps, brachialis and coracobrachialis

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11
Q

What is the sensory supply of the musculocutaneous nerve

A

Lateral border of forearm

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12
Q

Sensory supply of radial nerve

A

Lateral cutaneous nerve of arm
Posterior cutaneous nerve of arm
Posterior cutaneous nerve of forearm
Superficial branch - terminal division - dorsal surface of lateral 3 and 1/2 digits and dorsum of hand

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13
Q

Number 1, 3, 6, 11, 13,14,16,17,18,19,20,21,25,26,27

A

1: Axillary nerve
3: Coracobrachialis
6: Lateral cord of brachial plexus
11: Lower sub scapular nerves
13: Medial cutaneous nerve of arm
14: Medial cutaneous nerve of forearm
16: Medial root of median nerve
17: Median nerve
18: Musculocutaneous nerve
19: Pec minor and lateral pectoral nerve
20: Posterior cord
21: Radial nerve
25: Thoracodorsal nerve
26: Ulnar nerve
27: Upper sub scapular nerves

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14
Q
A

A - anterior view
B - posterior view
C - medial view
D - lateral view

1- anatomical neck
2- deltoid tuberosity
3- greater tubercle
4- groove for radial nerve
5- head
6- inter tubercular groove
7- lateral lip of inter tubercular groove
8- lesser tubercle
9- medial lip of intertubercular groove
10- surgical neck

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15
Q

2, 3, 5, 6,7,8,10,12,13

A

A - anterior
B - posterior
2- capitulum
3- coronoid fossa
5-lateral epicondyle
6-lateral supracondylar ridge
7-medial epicondyle
8-medial supracondylar ridge
10-olecranon fossa
12- radial fossa
13-trochlea

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16
Q

2,4,5,7,8,11

A

A - anterior
B- posterior
C-medial
D- lateral
2- Anterior oblique line
4- head
5- interosseous border
7- neck
8- posterior border
11- tuberosity

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17
Q

How do you articulate the elbow joint

A

Capitulum of humerus + radial head
Trochlea of humerus + trochlear notch of ulna
Olecranon of ulna + olecranon fossa of humerus

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18
Q

What is the bony prominence that EPL tendon wraps around

A

Lister tubercle

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19
Q

6, 11, 12

A

A - anterior
B- posterior
C- medial
D- lateral
6- olecranon
11 - trochlear notch
12 - tuberosity

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20
Q

3, 7

A

E - anterior
F - posterior
G- medial
H- lateral
3- head
7- styloid process

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21
Q

Identify the carpal bones

A
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22
Q

What is the blood supply of the scaphoid artery and what is its clinical significance

A

Receives blood supply from the palmar and dorsal branches of the radial artery. The proximal portion relies on retrograde flow from the distal portion which can result in avascular necrosis

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23
Q

16,25 and 23

A

16 - median nerve
25 - ulnar nerve
23 - ulnar artery (moved laterally to allow visualisation of ulnar nerve)

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24
Q

Sensory supply of median nerve

A

Lateral 2/3 of palm of hand - palmar cutaneous branch
Palmar digital branch:
Lateral 3 and 1/2 digits on palmar side
Dorsum of tips of index and middle fingers and thumb

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25
Motor action of median nerve in hand
Lateral 2 lumbricals Opponens Pollicis Abductor pollicis brevis Flexor policis brevis
26
What sits in the inter tubercular groove of the humerus
Tendon of long head of biceps
27
What sits in the spiral groove of radius
Radial nerve
28
How to orientate the lower end of the humerus
Medial epicondyle ismost prominent, Olecranon fossa is posterior
29
How to orientate the radius
Upper part - radial head Radial tuberosity is anteromedial
30
What notches are there in the ulna
Radial notch and trochlear notch
31
Ulnar nerve injury at wrist features
Complete clawing of hand - hyperextension of MCPJ and flexion of PIPJ - paralysis of the medial lumbricals and interossei Loss of sensation medial 1/3 of palmar aspect of hand and medial 1 and 1/2 fingers
32
Ulnar paradox
In proximal ulnar nerve injuries, FCU and ulnar part of FDP also affected, causing decreased flexion of DIPJs and clawing is thus only partial
33
Attachments of flexor retinaculum
Proximal Medial - pisiform Lateral - tubercle of scaphoid Distal Medial - hook of hamate Lateral - tubercle of trapezium
34
Structures passing through carpal tunnel
4 tendons of FDS 4 tendons of FDP 1 tendon of FPL 1 tendon of FCR Median nerve
35
31, 30, 27, 29
27 - radial artery 31 - ulnar artery 30 - superficial branch of radial artery 29 - superficial palmar arch
36
Flexion of the thumb muscles and innervation
Flexor pollicis longus - AIN Flexor pollicis brevis - recurrent branch of median
37
Extension of the thumb and innervation
Extensor pollicis longs and brevis - PIN
38
Abduction of thumb and innervation
Abductor longus - PIN Abductor brevis - recurrent branch median nerve
39
Adduction of thumb and innervation
adductor pollicis - deep branch of ulnar nerve
40
Opposition of thumb and innervation
Opponens policis, flexor pollicis brevis - recurrent branch of median nerve
41
Where does the tendon of FDS insert
Splits and inserts on either side of middle phalanx
42
Where does the tendon of FDP insert
Goes through split FDS tendon to insert to base of terminal phalanx
43
How to test FDP
Fix the PIPJ to eliminate action of FDS
44
How to test FDS
Fix the adjacent fingers in extension to eliminate action of FDP on adjacent fingers
45
How to test ulnar artery
Allens test Elevate the hand and make a fist for 30 seconds Occlude the ulnar and radial arteries Open the hand - it will be blanched Open the ulnar artery - it should reperfuse the hand
46
On doing a power grip of the hand, what is the role of the radial nerve
It supplies wrist extensors which give a mechanical advantage to power grip by synergistic activity causing more efficient flexion of the digits
47
Why is hand grip more powerful in extension than in flexion
The flexor muscles in an extended position are in a state of tension so contraction in this position is more powerful
48
Identify all
1- Extensor digitorum tendon 2- Extensor indices tendon 3- intertendinous connections 4- 1st dorsal interosseus 5- radial styloid process 6- ulnar styloid process 7- extensor carpi ulnaris 8- abductor digiti minimi 9-extensor carpi radialis longus tendon 10- extensor carpi radialis brevis tendon
49
What is the origin, insertion and action of the 1st dorsal interosseous muscle
Origin - 1st MC bone Insertion - lateral side of extensor expansion of index finger Action - abduction of index finger, flexion of MCPJ and extension of PIPJ and DIPJ
50
Which tendon is attached to the pisiform bone
flexor carpi ulnaris
51
What attaches extensor tendons to the phalanges
Extensor expansion
52
Which structure prevents subluxation of extensor tendons on metacarpal bones
Extensor retinaculum
53
What are the functions of intertendinous connections
1. Co-ordinating movement between tendons 2. Transmitting tension between muscles 3. Providing mechanical support to the tendons 4. Reducing friction between the tendons 5. Maintaining alignment of the tendons
54
Anatomical snuff box boundaries and contents
Anterolateral - tendon of abductor policis longus and extensor policis brevis Posteromedial - extensor policis longus tendon Contents - radial artery, superficial branch radial nerve, cephalic vein
55
How many compartments are below the extensor retinaculum
6
56
What is the content of compartment 3
EPL tendon
57
1,2,5,6,7,8,9,10,11,12,14,15,16,17,19
1- Abductor digiti minimi 2 - abductor pollicis longus 5- ECR brevis 6 - ECR longus 7-ECU 8- extensor digiti minimi 9- extensor digitorum 10- extensor indicis 11- extensor pollicis brevis 12- extensor pollicis longus 14- first dorsal interosseous 15- fourth dorsal interosseous 16- second dorsal interosseous 17- styloid process of ulna 19 - third dorsal interosseous
58
What is in each extensor compartment of the hand
1 - tendons of APL and EPB 2 - ECRL and ECRB 3- EPL 4- ED and EI 5- EDM 6- ECU
59
Guyon's canal borders
Medial - pisiform, FCU tendon, ADM muscle Lateral - hook of hamate Roof - palmar carpal ligament Floor - flexor retinaculum
60
Contents of guyon's canal
Ulnar nerve, ulnar artery, venae comitantes of ulnar artery, lymphatics Ulnar nerve bifurcates in the canal into superficial and deep branches
61
Boundaries of the cubital fossa
Superolateral - brachioradialis muscle Medial - pronator teres Floor - brachialis
62
Contents of cubital fossa from medial to lateral
Median nerve Brachial artery Biceps tendon
63
What structures pass in the spiral groove
Radial nerve, profunda brachii vessels
64
What are the symptoms of radial nerve injury at the spiral groove
Paralysis of wrist extensors - wrist drop Paralysis of finger extensors - finger drop Loss of sensation in 1st web space
65
Median nerve injury at elbow findings
Loss of flexion of index and middle fingers - unable to make a fist - paralysis of FDS and lateral half of FDP Flexion of the MCPJs of index and middle fingers can still be done - interosseous muscles are not affected Loss of flexion of distal phalanx of thumb - paralysis of FPL
66
Median nerve injury at the elbow or at the wrist
Ape like hand - flattening of thenar eminemce Thumb is adducted Opposition and abduction of thumb not possible - loss of pincer action Cause - paralysis and wasting of muscles of the thenar eminence. Adductor pollicis is unopposed
67
What complications can occur from supracondylar fracture of humerus
Brachial artery injury Median and AIN injury Ulnar nerve injury (less likely) Radial nerve injury (less likely)
68
4 - brachial artery 12 - median nerve 2 - AIN
69
What are the muscles of the rotator cuff
Supraspinatus Infraspinatus Teres minor Subscapularis
70
What is the origin and insertion of supraspinatus
Supraspinatus fossa to greater tuberosity
71
What is the origin and insertion of infraspinatus
Infraspinatus fossa to greater tuberosity
72
Origin and insertion of teres minor
Upper 2/3 of lateral border of scapula on dorsal aspect to greater tuberosity
73
Origin and insertion of subscapularis
Ventral aspect of scapula/ subscapular fossa to lesser tuberosity
74
Nerve supply to supra and infra spinatus Where does this nerve originate from
Suprascapular nerve From the upper trunks of the brachial plexus
75
Nerve supply of teres minor
Axillary nerve - posterior cord of the brachial plexus
76
Subscapularis nerve supply
Upper and lower subscapular nerves which are branches of the posterior cord
77
Which muscles are involved in abduction of shoulder joint
Supraspinatus - 0-15 deg Deltoid - 15-90 deg Trapezius and serrates anterior - >90 deg
78
What skeletal change accommodates abduction over 90 deg
Upward rotation of the scapula with external rotation of the humerus
79
Which factors decrease the stability of the shoulder joint
Shallow glenoid fossa with large humeral head Lax capsule with few ligaments Inferior aspect is not supported due to the presence of the quadrangular space
80
What is the main stabiliser of the shoulder joint
Rotator cuff muscles
81
Borders of the quadrangular space
Superior - teres minor Inferior - teres major Lateral - surgical neck of humerus Medial - long head of triceps
82
Contents of quadrangular space
Axillary nerve Posterior circumflex humeral vessels
83
Name 11,10, 14, 10, 12, 1 and 6
11 - teres minor 10 - teres major 14- long head of triceps 12 - surgical neck of humerus 1 - axillary nerve 6- posterior circumflex numeral vessels
84
Motor functions of the axillary nerve
Deltoid and teres minor
85
Sensory function of axillary nerve
Regimental patch area - skin of lower half of deltoid
86
Injury of axillary nerve
Inability to abduct the shoulder over 15 deg and loss of sensation over regimental patch area
87
Which muscle divides the axillary artery into 3 parts
Pectoralis minor muscle
88
What are the branches of 1st part of axillary artery
Superior thoracic artery
89
What are the branches of 2nd part of axillary artery
Thoraco acromial artery Lateral thoracic artery
90
Branches of 3rd part of axillary artery
Subscapular artery Anterior circumflex humeral Posterior circumflex humeral
91
Where does axillary artery continue as brachial artery
lower border of teres major muscle
92
Which muscles insert into bicipital groove
Lady between 2 majors Latissimus dorsi - between Teres major - medial lip Pectoralis major - lateral lip
93
Identify 1, 4, 6 and 5
1 - acromion 4- clavicle 5- deltoid 6- glenoid cavity
94
Origin and insertion of biceps
Origin Long head - supraglenoid tubercle Short head - coracoid process Insertion - radial tuberosity
95
nerve supply of biceps
Musculocutaneous nerve - lateral cord of brachial plexus
96
Origin and insertion of triceps
Origin Long head - infraglenoid tubercle Lateral head - Area of humerus above spiral groove Medial head - area below the spiral groove Insertion - olecranon process of ulna
97
Nerve supply of triceps
Radial nerve
98
What are the roots of the biceps reflex and how to test it
c5/6 Tap over finger over the biceps tendon
99
How to test the triceps reflex and what are the roots
Rest the forearm at 90 degrees and tap over the olecranon process c7
100
Supinator reflex
c6 4 inches proximal to base of the thumb with forearm supinated
101
Name 2, 10, 15 and 5
2 - acromion process 10 - spine of scapula 15 - supraspinus fossa 5 - infraspinus fossa
102
3, 11
3 - coracoid process 11- subscapular fossa
103
1,9,3,5
1- acromion 9- supraglenoid tubercle 3- glenoid fossa 5- infraglenoid tubercle
104
1,2,3,4,5
1 - acromial head 2 - conoid process 3- groove for subclavius muscle 4- impression for costoclavicular ligament 5- sternal head
105
How to orientate the clavicle
Rounded head - sternal head Flat head - acromial head Lower surface has a groove for origin of subclavius muscle, conoid process and costoclavicular ligament impression
106
What is the surface marking of the coracoid process
1cm below the point between the medial 3/4 and lateral 1/4 of the clavicle
107
Which structures attach to the coracoid process
Ligaments coracoacromial ligament coracoclavicular ligament Muscles 2 originate - coracobrachialis, short head of biceps 1 inserts - pectoralis minor
108
Origin and insertion of pec major
Origin - Clavicular head - medial half of anterior surface of clavicle Sternocostal head - sternum, upper 6 costal cartilages, external oblique aponeurosis Insertion - lateral lip of the bicipital groove
109
Nerve supply (and roots) of pec major
Medial and lateral pectoral nerves Medial - c8-t1 Lateral - c5-c7
110
Action of pec major
Adduction and medial rotation of arm Clavicular head - flexion of arm Sternocostal head - extend the flexed arm Accessory respiratory muscle
111
Trapezius origin and insertion
Origin - external occipital protuberance, superior nuchal line and spinous process of c7 - t12 Insetion - lateral surface of clavicle, medial acromion, spine of the scapula
112
Nerve supply of trapezius
Spinal accessory nerve
113
Serratus anterior origin and insertion
Origin - 9 slips to ribs 1-8 Insertion - medial border of scapula
114
Nerve supply of serratus anterior
Long thoracic nerve

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