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Anatomy MRCEM part 1 > Upper limb / axilla > Flashcards

Upper limb / axilla Flashcards

1
Q

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

Root

A

Flexor compartment of the arm
Coracobrachialis, biceps brachi and brachialis

C5/6/7

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2
Q

What does radial nerve supply?

Roots

A

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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3
Q

What does the axillary nerve supply?

Roots

A

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

C5–6

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4
Q

What does the median nerve supply

Roots

A

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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5
Q

What does the ulnar nerve supply?

Roots

A

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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6
Q

Upper brachial plexus injury presentation

A

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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7
Q

Lower brachial plexus injury presentation

A

Klumpke’s plasy

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

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8
Q

Subscapularis

Action

Nerve supply

A

GH medial rotation

Upper and lowr subscapular nerve (posterior cord)

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9
Q

Teres major

Action

Nerve supply

A

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

Lower subscapular nerve

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10
Q

Lat Dorsi

Action

Nerve supply

A

ADDuction and medial rotation of GH joint and extension of shoulder

Thoracodorsal nerve

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11
Q

Trapezius

Action - upper / middle / lower

Nerve supply

A

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

Accessory nerve

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12
Q

Pectoralis major

Action

Nerve supply

A

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

Lateral and medial pectoral nerves

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13
Q

Pectoralis minor

Action

Nerve supply

A

Stabilises the scapula on the thorax

Lateral and medial pectoral nerves

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14
Q

Deltoid (Ant / Post/ Middle)

Action

Nerve supply

A

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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15
Q

Presentation of clavicle #

A

Drooped shoulder, medially rotated

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16
Q

Ligaments that re-inforce the AC joint

A

Coracoclavicular ligaments (Trapezoid and conoid)

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17
Q

Intrinsice ligament of AC joint

A

Acromioclavicular ligament

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18
Q

Movements of the AC joint

A

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

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19
Q

Ligaments forming the Sternoclavicular joint

A

Interclavicular ligament
Anterior stenoclavicular ligament
Costoclavicular ligament

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20
Q

What do ALL rotator muscles do?

A

ALL stabalise the GH joint

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21
Q

Rotator cuff muscle position & movements:

S
I
T
S

A

Supraspinatius - posterior, first 15 degrees of ABDuction

Infraspinatus - posterior, lateral rotation

Teres minor - posterior, lateral rotation

Subscapularis - anterior, medial rotation

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22
Q

ABDuction of the shoulder

First 15 degrees
Up to 90 degrees
Beyond here

A

Supraspinatus
Deltoid
Trapezius

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23
Q

Test for supraspinatus injury on exam

A

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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24
Q

Test for infraspinatus + teres minor injury on exam

A

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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25
Q

Test for supraspinatus on exam

A

Lift off test (behind back)

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26
Q

Biceps brachii

Action

Nerve supply

A

Flex shoulder and elbow
Supinates
forearm

Musculocutaneous nerve

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27
Q

Brachialis

Action

Nerve supply

A

Flexes the elbow

Musculocutaneous nerve

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28
Q

Coracobrachilais

Action

Nerve supply

A

Flexes the shoulder

Musculocutaneous nerve

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29
Q

Biceps tendon reflex tests which ROOT?

A

C6

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30
Q

What does the Musculocutaneous nerve become?

A

Lateral cutaneous nerve of the forearm

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31
Q

Triceps brachii

Action

Nerve supply

A

Extends the forearm at the elbow joint

Radial nerve

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32
Q

What prevents superior dislocation of the humerus

A

Coracoacromial arch

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33
Q

How does the radial nerve lie along the humerus

A

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

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34
Q

Veins of the arm and position

Connected by what at the cubital fossa?

A

Cephalic - laterally
Basilic - medially

Median cubital vein

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35
Q

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

A

Surgical next of humerus

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36
Q

Where is the ulnar nerve

A

Medial epicondyle

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37
Q

Ligaments of the elbow

A

Collateral (lie laterally)

& annular ligament

38
Q

Aetiology of the ‘pulled elbow’

A

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

39
Q

Muscles involved in supination

A

Biceps brachii
Brachioradialis
Supinator

40
Q

Muscles involved in pronation

A

Prontator quadratus
Prontator teres

41
Q

Major contents of the cubital fossa

Medial -> lateral

A

Median cutaenous nerve of the forearm

median nerve

brachial artery

biceps tendon

radial nerve

42
Q

Medial and lateral wall of the ACF

A

Pronator teres
Brachioradialis

43
Q

Flexors of the forearm originate…

A

from the medial epicondyle

44
Q

Extensors of the forearm originate…

A

from the lateral epicondyle

45
Q

Tennis elbow

A

Epicondylitis of the lateral epicondlye (extensors)

tEnnis elbow

46
Q

Golf elbow

A

Epicondylitis of the medial epicondlye (extensors)

golF elbow

47
Q

What is at risk in a supracondylar #

A

Occlusions of brachial artery

also risk to median, ulnar and radial nerves

48
Q

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

A

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

49
Q

Which carpal bones does the radius articulate with?

A

Scaphoid and lunate

50
Q

3 layers of anterior forearm muscles

How many in each layer?

A

Superficial - 4

Intermediate - 1

Deep - 3

51
Q

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

A

Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris

52
Q

Which muscle lies in the intermediate layer of the ant. forearm

And where does it’s tendons insert

A

Flexor digitorum superficialis

Pass deep to the flexor retinaculum and insert onto the middle phalanges

53
Q

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

A

Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus S

54
Q

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

A

Median nerve

55
Q

Surface marking for radial artery at the wrist

A

Lateral to the flexor carpi radialis tendon

56
Q

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

A

Intermediate/deep layer, between FDS and FDP

57
Q

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

A

Either side of the FDS

58
Q

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

A

Superficial layer

59
Q

Branches of the brachial artery (2)

A

Radial and ulnar artery

60
Q

Branches of the ulnar artery (2)

A

Ulnar collateral
Common interosseous artery

61
Q

Branches of the common interosseous artery

A

Ant. and post.

62
Q

Where are the NV structures at risk in the lower arm

A

ACF and radiocarpal joint (wrist)

63
Q

What nerve supplies the posterior forearm

A

Posterior interoessous nerve

64
Q

Colles # =

A

following a fall on the hand

Involves the distal radius

Often presents as a dinner fork deformity

65
Q

Borders of the anatomical snuff box

Medial
Lateral
Proximal
Floor
Roof

A

Tendon of EPL

Tendon of abductor PL and EPB

Styloid process of radius

Carpal bones, scaphoid and trapezium

Skin

66
Q

Superficial muscles of the posterior forearm

A

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

67
Q

Deep muscles of the posterior forearm

A

Supinator
APL
EPB
EPL
Extensor indicis

68
Q

Carpal bones of the hand order

Radial -> ulnar (1st layer)
2nd layer

A

Scaphoid
Lunate
Triquetral
Pisiform

Trapeszium (back at the thumb)
Capitate
Hamate

69
Q

What forms the roof of the carpal tunnel?

A

Flexor retinaculum

70
Q

3 thenar muscles?

A

Abductor pollicis
Flexor pollicis
Opponens pollicis

71
Q

Which nerve supplies the thenar muscles?

hypothenar…

A

Median nerve

Ulnar

72
Q

3 hypothenar muscles?

A

Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi

73
Q

Fracture of rib one may compromise which artery?

A

Distal subclavian

74
Q

Anterior dislocation of the humeral head may compress what artery?

A

Axillary artery

75
Q

Laceration of the wrist puts which nerves at risk?

A

Median and ulner

76
Q

Medial epicondyle # puts which nerve at risk?

A

Ulnar nerve

77
Q

Which groups of muscles provide the ‘power grip’

A

Extrinsic forearm muscles

78
Q

Which muscles provide the pinch grip

A

Intrinsic muscles

79
Q

Actions of the lumbricals

A

Flex the MP
Extend the IP

80
Q

Actions of the interossei

A

Flex the MP
Extend the IP

81
Q

What supplies adductor pollicis

A

Ulnar nerve

82
Q

Which muscles make up the thenar muscles?

And what nerve supplies them?

A

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

83
Q

What is froment’s test

A

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.

84
Q

Where does the FDS tendons split?

A

As it inserts on the middle phalange

85
Q

Where doe the tendons of FDP insert?

A

Distal phalanges

86
Q

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

A

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

87
Q

Where is musculocutaenous nerve commonly injured?

A

Stab wound in axilla

88
Q

Motor and sensory loss in musculocutaenous nerve injury

A

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

Sensory loss: Lateral aspect of forearm

89
Q

What is the flexor retinaculum attached to laterally?

medially

A

Scaphoid & trapezium

Pisiform and hook of hamate

90
Q

Attachments of extensor retinaculum:

Medially

Laterally

A

Pisiform and triquestrum

Anterolateral to the radius above the styloid

90
Q
A
91
Q
A

Anatomy MRCEM part 1 (7 decks)

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