Upper limb / axilla Flashcards by Charlotte Underwood

Which muscle group (and muscles) does the musculocuaenous nerve supply?

Root

Flexor compartment of the arm
Coracobrachialis, biceps brachi and brachialis

C5/6/7

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What does radial nerve supply?

Roots

All extensor muscles of the arm and forearm, all posterior skin of arm / forearm / hand

C 5/6/7/8/ T1

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What does the axillary nerve supply?

Roots

Deltoid, teres minor, skin over lower part of deltiod (regimental patch)

C5–6

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What does the median nerve supply

Roots

All flexor muscles of the forearm
(except for the flexor carpi ulnaris and the medial half of the flexor digitorum profundus)

The thenar muscles (flexor pollicis brevis, abductor pollicis brevis, opponens pollicis) and the lateral two lumbricals

Skin over lateral palm and lateral 3 1/2 digits including nail beds

C5/6/7/8, T1

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What does the ulnar nerve supply?

Roots

flexor carpi ulnaris and the medial half of the flexor digitorum profundus

Majority of intrinsic muscles of the hand

Skin over palm and medial 1 1/2 digits

C8.- T1

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Upper brachial plexus injury presentation

Erbs palsy
Arm hangs by side, rotated medially, forearm extended and pronated

Loss of sensation in the arm and paralysis / atrophy of deltoid / biceps & brachialis muscle

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Lower brachial plexus injury presentation

Klumpke’s plasy

Paralysis / atrophy of intrinsic muscles of the hand + flexors of wrist / hand

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Subscapularis

Action

Nerve supply

GH medial rotation

Upper and lowr subscapular nerve (posterior cord)

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Teres major

Action

Nerve supply

ADDuction and medial rotation of GH joint, and extension of shoulder

Lower subscapular nerve

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Lat Dorsi

Action

Nerve supply

ADDuction and medial rotation of GH joint and extension of shoulder

Thoracodorsal nerve

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Trapezius

Action - upper / middle / lower

Nerve supply

Upper elevates the scapula
Middle retracts the scapula
Lower depresses and laterally rotates the scapula

Accessory nerve

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Pectoralis major

Action

Nerve supply

ADDuction of GH joint
Medial rotation
Flexion of extended arm
Extension of flexed arm

Lateral and medial pectoral nerves

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Pectoralis minor

Action

Nerve supply

Stabilises the scapula on the thorax

Lateral and medial pectoral nerves

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Deltoid (Ant / Post/ Middle)

Action

Nerve supply

ANTERIOR
Flexes the humerus at the GH
Medially rotates the humerus at GH

MIDDLE
ABDucts at GH joint
Attaches limb to pectoral girdle

POSTERIOR
Extends the humerus at GH
Laterally rotates the humerus at GH

Axillary nerve

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Presentation of clavicle #

Drooped shoulder, medially rotated

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Ligaments that re-inforce the AC joint

Coracoclavicular ligaments (Trapezoid and conoid)

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Intrinsice ligament of AC joint

Acromioclavicular ligament

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Movements of the AC joint

Retraction and protraction of the scapula
Elevation of the arm via rotation of the scapula

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Ligaments forming the Sternoclavicular joint

Interclavicular ligament
Anterior stenoclavicular ligament
Costoclavicular ligament

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What do ALL rotator muscles do?

ALL stabalise the GH joint

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Rotator cuff muscle position & movements:

S
I
T
S

Supraspinatius - posterior, first 15 degrees of ABDuction

Infraspinatus - posterior, lateral rotation

Teres minor - posterior, lateral rotation

Subscapularis - anterior, medial rotation

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ABDuction of the shoulder

First 15 degrees
Up to 90 degrees
Beyond here

Supraspinatus
Deltoid
Trapezius

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Test for supraspinatus injury on exam

Empty Can Test: Position the patient with arms elevated to 90 degrees in the scapular plane, with the elbow extended, and full medial rotation and pronation of the forearm with thumbs pointing downwards. Ask the patient to resist the downward force being applied to the forearm. Test is positive is patient has pain or weakness.

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Test for infraspinatus + teres minor injury on exam

Infraspinatus Test: Position the patient with the arm fully adducted, with the elbow flexed to 90 degrees. Ask the patient to resist the medially directed force to the arm. Test is positive if patient has pain or weakness.

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Test for supraspinatus on exam

Lift off test (behind back)

Biceps brachii Action Nerve supply

Flex shoulder and elbow Supinates forearm Musculocutaneous nerve

Brachialis Action Nerve supply

Flexes the elbow Musculocutaneous nerve

Coracobrachilais Action Nerve supply

Flexes the shoulder Musculocutaneous nerve

Biceps tendon reflex tests which ROOT?

What does the Musculocutaneous nerve become?

Lateral cutaneous nerve of the forearm

Triceps brachii Action Nerve supply

Extends the forearm at the elbow joint Radial nerve

What prevents superior dislocation of the humerus

Coracoacromial arch

How does the radial nerve lie along the humerus

In the spiral groove in direct contact with the bone, with the profunda brachii artery

Veins of the arm and position Connected by what at the cubital fossa?

Cephalic - laterally Basilic - medially Median cubital vein

Where is the axillary nerve at risk in terms of a #

Surgical next of humerus

Where is the ulnar nerve

Medial epicondyle

Ligaments of the elbow

Collateral (lie laterally) & annular ligament

Aetiology of the 'pulled elbow'

Dislocation of the. radial head from the annular ligament in children

Muscles involved in supination

Biceps brachii Brachioradialis Supinator

Muscles involved in pronation

Prontator quadratus Prontator teres

Major contents of the cubital fossa Medial -> lateral

Median cutaenous nerve of the forearm median nerve brachial artery biceps tendon radial nerve

Medial and lateral wall of the ACF

Pronator teres Brachioradialis

Flexors of the forearm originate...

from the medial epicondyle

Extensors of the forearm originate...

from the lateral epicondyle

Tennis elbow

Epicondylitis of the lateral epicondlye (extensors) tEnnis elbow

Golf elbow

Epicondylitis of the medial epicondlye (extensors) golF elbow

What is at risk in a supracondylar #

Occlusions of brachial artery also risk to median, ulnar and radial nerves

Why is the radius more likely to be # in the wrist?

Ulnar doesn't articulate with the carpals to radius takes the full force

Which carpal bones does the radius articulate with?

Scaphoid and lunate

3 layers of anterior forearm muscles How many in each layer?

Superficial - 4 Intermediate - 1 Deep - 3

Which muscles lie in the superficial layer of the ant. forearm

Pronator teres Flexor carpi radialis Palmaris longus Flexor carpi ulnaris

Which muscle lies in the intermediate layer of the ant. forearm And where does it's tendons insert

Flexor digitorum superficialis Pass deep to the flexor retinaculum and insert onto the middle phalanges

Which muscles lie in the deep layer of the ant. forearm

Flexor digitorum profundus Flexor pollicis longus Pronator quadratus S

Plamaris longus is the surface marker for what at the wrist?

Median nerve

Surface marking for radial artery at the wrist

Lateral to the flexor carpi radialis tendon

Where do the ular and median nerve lie in the anterior forearm

Intermediate/deep layer, between FDS and FDP

Which muscle lies in the superficial layer of the ant. wrist

Either side of the FDS

Which layer of the anterior forearm does the radial nerve. and artery sit?

Superficial layer

Branches of the brachial artery (2)

Radial and ulnar artery

Branches of the ulnar artery (2)

Ulnar collateral Common interosseous artery

Branches of the common interosseous artery

Ant. and post.

Where are the NV structures at risk in the lower arm

ACF and radiocarpal joint (wrist)

What nerve supplies the posterior forearm

Posterior interoessous nerve

Colles # =

following a fall on the hand Involves the distal radius Often presents as a dinner fork deformity

Borders of the anatomical snuff box Medial Lateral Proximal Floor Roof

Tendon of EPL Tendon of abductor PL and EPB Styloid process of radius Carpal bones, scaphoid and trapezium Skin

Superficial muscles of the posterior forearm

Extensor carpi radialis brevis Extensor digitorum Extensor carpi ulnaris Extensor digiti minimi Brachioradialis Extensor carp radialis longus

Deep muscles of the posterior forearm

Supinator APL EPB EPL Extensor indicis

Carpal bones of the hand order Radial -> ulnar (1st layer) 2nd layer

Scaphoid Lunate Triquetral Pisiform Trapeszium (back at the thumb) Capitate Hamate

What forms the roof of the carpal tunnel?

Flexor retinaculum

3 thenar muscles?

Abductor pollicis Flexor pollicis Opponens pollicis

Which nerve supplies the thenar muscles? hypothenar...

Median nerve Ulnar

3 hypothenar muscles?

Abductor digiti minimi Flexor digiti minimi Opponens digiti minimi

Fracture of rib one may compromise which artery?

Distal subclavian

Anterior dislocation of the humeral head may compress what artery?

Axillary artery

Laceration of the wrist puts which nerves at risk?

Median and ulner

Medial epicondyle # puts which nerve at risk?

Ulnar nerve

Which groups of muscles provide the 'power grip'

Extrinsic forearm muscles

Which muscles provide the pinch grip

Intrinsic muscles

Actions of the lumbricals

Flex the MP Extend the IP

Actions of the interossei

Flex the MP Extend the IP

What supplies adductor pollicis

Ulnar nerve

Which muscles make up the thenar muscles? And what nerve supplies them?

adductor pollicis, abductor pollicis brevis, flexor pollicis brevis and opponens pollicis.

What is froment's test

The Froment's sign test is performed to determine the presence of an ulnar nerve injury. Bending the thumb when pinching a piece of paper is a sign of an ulnar nerve injury.

Where does the FDS tendons split?

As it inserts on the middle phalange

Where doe the tendons of FDP insert?

Distal phalanges

Why is paraesthesia of the palm not found in true carpal tunnel?

Nerve that supplies the lateral palm is a branch that runs superior to the flexor retinaculum §

Where is musculocutaenous nerve commonly injured?

Stab wound in axilla

Motor and sensory loss in musculocutaenous nerve injury

Motor loss: Weakness of flexion and supination of the forearm, weakness of arm flexion Sensory loss: Lateral aspect of forearm

What is the flexor retinaculum attached to laterally? medially

Scaphoid & trapezium Pisiform and hook of hamate

Attachments of extensor retinaculum: Medially Laterally

Pisiform and triquestrum Anterolateral to the radius above the styloid