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MRCEM Primary > Upper limb neuromuscular supply > Flashcards

Upper limb neuromuscular supply Flashcards

1
Q

Which spinal roots contribute to the axillary nerve?

A

C5 + C6

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2
Q

What are the sensory functions of the axillary nerve?

A

gives rise to upper lateral cutaneous nerve of the arm = innervates skin over lower deltoid (regimental badge area).

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3
Q

What muscles are innervated by the axillary nerve?

A

Teres minor and deltoid

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4
Q

Which mechanisms of injury can commonly affect the axillary nerve?

A

Fracture of humeral surgical neck
Shoulder dislocation

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5
Q

If the axillary nerve is disrupted, which motor function if pathognomonic?

A

Unable to abduct arm to >15 degrees.

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6
Q

If the axillary nerve is damaged, which sensory impairment is pathognomonic?

A

Loss of sensation over regimental badge area.

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7
Q

What is era’s palsy?

A

Clinical condition resulting from damage to C5 and C6 roots of brachial plexus.

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8
Q

What causes era’s palsy?

A

Excessive increase in angle between neck and shoulder = stretches nerve roots.

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9
Q

In erb’s palsy, how will a patient normally hold their arm?

A

Internally rotated adduction.

**Unable to externally rotate or abduct their arm.

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10
Q

Which nerve roots form the musculocutaneous nerve?

A

C5, C6, C7

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11
Q

What are the motor functions of the musculocutaneous nerve?

A

Anterior compartment of arm (biceps, coarcobrachialis, brachialis)

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12
Q

What are the sensory functions of the musculocutaneous nerve?

A

Innervates anterolateral aspect of forearm (lateral cutaneous nerve)

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13
Q

Which movements is the musculocutaneous nerve responsible for?

A

Flexion of arm at elbow and shoulder.
Biceps also supinates forearm.

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14
Q

Which mechanisms of injury can commonly damage the musculocutaneous nerve?

A

Penetrating trauma to axilla

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15
Q

What clinical findings are present if there is damage to the musculocutaneous nerve?

A

Loss of sensation over anterolateral aspect of forearm
Elbow and shoulder flexion are weakened
Forearm supination is weakened

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16
Q

Which nerve roots form the median nerve?

A

C6, C7, C8, T1

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17
Q

What are the sensory function of the median nerve?

A

Lateral aspect of the palm (palmar cutaneous branch)
Lateral 3 and a half fingers anteriorly (digital cutaneous branch)
Lateral 3 fingertips

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18
Q

What is the motor function of the median nerve?

A

Flexor (anterior) compartment of forearm (not FCU or lateral half of FDP)
Thenar muscles
Lateral 2 lumbricals

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19
Q

What movements do muscles supplied by the median nerve do?

A

Forearm pronation
Wrist flexion
Digital flexion
Thumb flexion, opposition and adduction
Index and middle finger MCP flexion + IP extension

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20
Q

How is the median nerve normal damaged at the elbow?

A

Supracondylar fracture of the humerus

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21
Q

What characteristic sign is seen when the median nerve is damaged?

A

Hand of benediction.

22
Q

How is the median nerve often damaged at the wrist?

A

Lacerations just proximal to flexor retinaculum.

23
Q

Which nerve roots form the radial nerve?

A

C5 to T1.

24
Q

What is the motor function of the radial nerve?

A

Triceps
Extensor (posterior) muscles of forearm.

25
Q

What are the sensory innervations of the radial nerve?

A

Skin of posterior arm
Lateral aspect of dorsum of hand
Dorsal surface of lateral 3 and a half digits

26
Q

How can the radial nerve be damaged at the axilla?

A

Shoulder dislocation
Proximal humerus fracture
Excessive pressure on the nerve within the axilla

27
Q

What characteristic sign is seen with radial nerve damage?

A

Wrist drop

28
Q

How can the radial nerve be damaged at the radial groove?

A

Fracture of the humeral shaft

29
Q

How can the deep branch of the radial nerve be injured in the forearm?

A

Fracture of radial head or posterior dislocation of the radius

30
Q

How can the superficial branch of the radial nerve be injured in the forearm?

A

Stabbing or laceration of the forearm

31
Q

If the superficial branch of the radial nerve is damaged what happens to motor function?

A

No effect.

**Superficial branch is purely sensory.

32
Q

If the deep branch of the radial nerve is injured, what happens to sensory function?

A

No effect.

33
Q

Which nerve roots form the ulnar nerve?

A

C8 -T1.

34
Q

What is the sensory innervation of the ulnar nerve?

A

Medial one and a half fingers and associated palm area.

35
Q

What are the motor functions of the ulnar nerve?

A

FCU
Medial half FDP
Intrinsic muscles of hand (except thenar muscles and lateral 2 lumbricals).

36
Q

What is a common test for ulnar nerve palsy?

A

Froment’s test

37
Q

Why is the ulnar claw worse when the ulnar nerve is damaged at the wrist compared to when damaged at the elbow?

A

Because the FDP is intact.

38
Q

What are the 5 main vessels providing blood supply to the upper limb?

A

Subclavian artery
Axillary artery
Brachial artery
Radial artery
Ulnar artery

39
Q

When does the subclavian artery become the axillary artery?

A

At the lateral border of the 1st rib when it enters the axilla.

40
Q

When does the axillary artery become the brachial artery?

A

As it passes the lower border of Teres major.

41
Q

Which vessels supply the triceps?

A

The profunda brachii arteries

42
Q

When does the brachial artery become the ulnar and radial arteries?

A

It bifurcates underneath the bicipital aponeurosis after moving through the curtail fossa.

43
Q

Where do the radial and ulnar arteries terminate?

A

Anastamose in the hand by forming two arches (superficial palmar arch and deep palmar arch)

44
Q

Which palmar arch gives rise to the digital arteries?

A

Superficial palmar arch

45
Q

What are the major superficial veins of the upper limb?

A

Cephalic and basilic

46
Q

Which vein connects the cephalic and basilica veins?

A

Median cubital vein

47
Q

Which is the more medial superficial vein?

A

Basilic vein

48
Q

Which is the more lateral superficial vein?

A

Cephalic vein

49
Q

Which are the largest deep veins of the arm?

A

Brachial veins

50
Q

Where are the brachial veins situation?

A

Either side of the brachial artery

MRCEM Primary (39 decks)

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