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MRCS part B anatomy > Upper limb prosection book > Flashcards

Upper limb prosection book Flashcards

1
Q

What muscles are involved in forward flexion of shoulder?

A

Anterior fibres of deltoid

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2
Q

Describe important features of scapula

A

-Supraspinous fossa
-Infraspinous fossa
-Coracoid process
-Acromion
-Spine of scapula

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3
Q

Describe ‘painful arc’

A

-Usually inflammation supraspinatous tendon
-Due to degeneration/trauma
-Painful abduction arm between 60-120 degrees

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4
Q

What is the brachial plexus?

A

-Network of nerves that originates in neck and extends into axilla
-Gives rise to most of nerves that supply upper limb

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5
Q

What are the 5 regions of the brachial plexus?

A

Roots
Trunks
Divisions
Cords
Branches

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6
Q

Describe the origins of the brachial plexus

A

Originates from ventral rami c5-T1

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7
Q

How many branches are there from divisions of brachial plexus?

A

None: all branches exit brachial plexus before or after the divisions

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8
Q

How many branches from roots of brachial plexus?

A

3:
-Dorsal scapular nerve from C5
-Nerve to subclavius from c5 and c6
-Long thoracic nerve c5-c7

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9
Q

What is the nerve roots of long thoracic nerve?

A

Long thoracic nerve of bell
C5,6,7 bells in heaven

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10
Q

How many branches from trunks of brachial plexus? Where are they from?

A

1
-suprascapular nerve (upper trunk)

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11
Q

Draw a line diagram of brachial plexus and label branches

A

label branches

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12
Q

Name salient parts of humerus

A

Greater tubercle
Lesser tubercle
Intertubercular (bicipital) groove
Medial epicondyle
Trochlea (medial: we like trotsky more than stalin)
Capitulum

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13
Q

Name muscles attaching to humerus

A

Pec major
LD
Teres major
Deltoid (deltoid tuberosity)

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14
Q

How would you localise humerus as left or right?

A

With humeral head pointing inwards, capitulum and trochlea point forwards

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15
Q

What are the boundaries of the axilla?

A

Apex: cervicoaxillary canal (convergence of clavicle, scapular, first rib)

Anterior: pec major and minor

Base: axillary fascia

Posterior: subscapularis, teres major, lat dorsi (superior to inferior)

Medial: thoracic wall and serratus anterior

Lateral: intertubercular groove of humerus

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16
Q

What are contents of axilla?

A

-Axillary artery and branches
-Axillary vein
-Axillary lymph nodes
–> 1: below pec minor
–> 2: behind pec minor
–> 3: above pec minor
-Brachial plexus: cords and branches
-Fat

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17
Q

Structures that pierce clavipectoral fascia

A

Two in:
-Cephalic vein
-Lymphatic vessels

Two out:
-Thoraco-acromial trunk
-Lateral pectoral nerve

18
Q

What is the clavipectoral fascia?

A

Thin layer fibrous tissue surrounding pec minor
-Superiorly attaches to clavicle and inferiorly to axillary fascia

19
Q

What nerves could be damaged with humeral fracture?

A

-Axillary nerve as it passes close to neck of humerus in quadrangular space
-Radial nerve as it winds around shaft of humerus at junction between proximal 2/3rds and distal 1/3rd
-Ulnar nerve as it passes behind medial epicondyle
-Median nerve in supracondylar fracture

20
Q

What structures make up roof of cubital fossa?

A

Bicipital aponeurosis, deep fascia of forearm, subcut tissue, skin

21
Q

Where does the median cubital vein lie relative to bicipital aponeurosis?

A

Superficial to it

22
Q

Describe the anatomy of the cubital tunnel

A

-Roof: aponeurotic expansion of two heads flexor carpi ulnaris
-Spans from medial epicondyle of humerus to olecranon process of ulna
-Floor: medial collateral ligament of elbow
-medial border of olecranon process to medial epicondyle

23
Q

What is clinical significance of cubital tunnel?

A

-Ulnar nerve passes through cubital tunnel as it runs behind medial epicondyle
-Ulnar nerve can be compressed within cubital tunnel
-This results in ulnar nerve symptoms and signs within forearm and hand and is termed cubital tunnel syndrome

24
Q

What happens to tendons FDS and FDP?

A

-FDS tendon splits to insert into middle phalanges
-FDP tendon passes through this split in FDS to insert into base of distal phalanx

25
Q

What prevents tendons from bowstringing?

A

-Series of fascia coverings that anchor tendon to bony skeleton, while allowing tendons to glide smoothly
-At wrist: flexor retinaculum
-On fingers: annular (A1-5) and cruciate (C1-3) pulleys

26
Q

Describe flexor arrangement of pulleys:

A

A1: over MCP joint
A3: over PIPJ
A5: over DIPJ
A2: over proximal phalanx (most important pulley)
A4: pulley is over middle phalanx (second most important pulley)
C1: between A2 and A3
C2: between A3 and A4
C3: between A4 and A5

Proximal to distal: A1, A2, C1, A3, C2, A4, C3, A5

27
Q

Where does FDS and FDP insert?

A

FDP: base of distal phalanx
FDS: Inserts into base of middle phalanx

28
Q

How do you test FDS and FDP?

A

FDP: flexion of DIPJ
FDS: flexion of PIPJ with other fingers restrained

29
Q

What is the clinical significance of palmaris longus’s abscence in 10% of population?

A

Can be used as tendon graft.

30
Q

How many compartments are there in extensor retinaculum, and what runs through each one?

A

6 compartments. Radial to ulnar:
-EPB and APL
-ERCL, ECRB
-EPL
-Extensor indicis and extensor digitorum communis
-Extensor digiti minimi
-Extensor carpi ulnaris

31
Q

What are the layers you go through during open carpal tunnel release?

A

Skin
Subcut fat
Palmar fascia
Flexor retinaculum (entire length must be divided)

32
Q

What structures are at risk during open carpal tunnel decompression?

A

-Palmar cutaneous branch of median nerve (sensation to thenar eminence)
-Recurrent branch median nerve (motor branch to thenar muscles)
-Ulnar nerve as it passes through flexor retinaculum (with incision too far to ulnar side)
-Median nerve
-Superficial palmar arch
-Flexor tendons passing through carpal tunnel

33
Q

Contents of anatomical snuffbox

A

Radial artery
Radial nerve
ECRL+ECRB tendons

34
Q

Describe pathology of scaphoid fracture

A

-Avascular necrosis proximal pole
-Retrograde blood supply from distal pole via radial artery branches
-Can present after months with pain and stiffness
-Can progress to disruption neighbouring carpal attachments: ‘SNAC wrist’ (scaphoid non-union advanced collapse)
-Early detection + immobilisation in cast or ORIF reduces risk

35
Q

Describe upper limb dermatomes

A

C4: Upper shoulder, over clavicle
C5: Lateral arm below deltoid
C6: Thumb and radial hand/forearm
C7: Fingers 2, 3, 4
C8: finger 5
T1: Medial elbow

36
Q

Upper limb myotomes

A

C5 – Shoulder abduction
C6 – Elbow flexion
C7 – Elbow extension
C8 – Finger flexion
T1 – Finger abduction

37
Q

What are the terminal branches of radial artery in hand?

A

-Radial artery divides into princeps pollicis and radialis indicis
-Forms radial side of deep palmar arch of hand

38
Q

Which tendons of fingers are contained within a sheath? How far does it exend? What is function of flexor sheath? What is the clinical significance of this?

A

-Flexor tendons contained within synovial sheaths in hand
-Extend from A1 pulley in palm to A5 pulley at DIPJ

Infection in flexure sheath is devastating for 2 reasons:
1) -rigid fibro-osseous tunnel of flexor sheath cannot expand in presence of pus
-This leads to raised pressure + interruption of blood supply to flexor tendons.
-Ultimately leads to atrophic tendon ruptures

2) Scarring within flexor sheath following infection leads to adhesions between tendons and sheath
-leads to reduced tendon ROM, stiffness, loss of function

39
Q

Describe the pathological process that commonly affects the palmar fascia

A

-Dupuytren’s contracture
-Palmar aponeurosis is susceptible to progressive hyperplasia and fibrosis, with subsequent thickening and shortening
-Leads to flexion deformity of one or more digits, with associated loss of function

40
Q

What is pathological enlargement of PIPJ and DIPJ called?

A

PIPJ: bouchard’s nodes (RA)
DIPJ: Heberden’s nodes (OA)

41
Q

Reflexes nerve roots

A

1,2 buckle my shoe (S1-S2 ankle jerk)
3,4 kick the door (L3-L4 knee jerk)
5,6 pick up sticks (C5, C6 biceps jerk)
7,8 lay them straight (wrist jerk)

42
Q

Orientating cubital fossa:

A

-Medial epicondyle is more pointy (prominent)
-Basilic vein is more medial than cephalic vein is lateral, and travels further to reach median cubital vein

MRCS part B anatomy (16 decks)

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