MRCS part B > Upper limb > Flashcards

Upper limb Flashcards

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1
Q

lcoation of roots

A

posterior triangle
pass between scalenus anterior and medius

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2
Q

location of trunks

A

posterior to middle third of calvicle
upper and middle trunks superior to subclavian artery. lower trunk over 1st rib posterior to the subclavian artery

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3
Q

suprascapular branch of and supplies

A

superior trunk
supraspinatous and infraspinatous

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4
Q

Posterior cord branches

A

STARS
Subscapular upper
Thoracodorsal
Axillary
Radial
Suscapular lower

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5
Q

Branches of medial cord

A

5 M’s
Medial pectoral nerve
Medial cutaneous nerve of arm
Medial cutaneous nerve of forearm
Ulnar
Median

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6
Q

Long thoracic nerve branches supply which muscle

A

C5-7
serratus anterior

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7
Q

Parts of brachial plexus found

Roots
Trunks
Divsions
Cords

A

Roots: exits from IV foramina between anterior and medius scalene

Trunks: base of the posterior triangle of the neck and behind the 3rd part of the subclavian artery

Divisions: behind middle 1/3 of the clavicle

Cords: related to the 2nd part of axillary artery

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8
Q

What is erbs palsy

A

C5-C6 - upper nerve roots
Motor affection: waiters tip
arm adduction - paralysis of arm abductors which is deltoid and supraspinatous

arm internal rotation - paralysis of arm external rotators infraspinatous and teres minor

forearm extension and pronation paralysis of forearm flexors and supinators BBC

sensory affection: loss of sensation of radial side of arm and forearm

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9
Q

What is Klumpke’s paralysis

A

C8-T1
Motor: paralysis of intrinsic muscles of the hand, paralysis of wrist flexors except flexor carpi radialis, unopposed action of the long flexors and extensors and wrist extension
hyperextension of MCP joints with flexion of IP joints

sensory: loss of sensation over ulnar border of forearm and hand

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10
Q

coracoid process attachments of muscles/ligaments

A

short head of biceps brachii and coracobrachialis and pectoralsi minor.

ligaments: coracoclavicular/coracoarcromial/coracohumeral

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11
Q

what attaches to the supraglenoid tubercule

A

long head of biceps

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12
Q

what is attached to the infraglenoid tubercule

A

Triceps

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13
Q

Origin
Insertion
Action
Innervation of deltoid

A

lateral clavicle and scapula
insertion: humerus deltoid tuberosity

anterior fibres:flexion and medial rotation
posterior fibres: extension and lateral rotation
middle fibres: the major abductor of the arm after 15 degrees

axillary nerve

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14
Q

Rotator cuff muscles

A

SITS

Subscapularis - subscapular fossa/humerus -> lesser tuberosity. Action: internally rotation arm. upper and lower subscapular nerves.

Greater tuberosity: Supraspinatous - abducting /infraspinatous/Teres minor- axillary nerve

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15
Q

Triangular space - borders

A

Borders
Superior: Teres minor
Inferior Teres Major
Lateral Triceps

circumflex scapular artery

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16
Q

Quadrangular space borders

What passes through it

A

superior: Teres minor, inferior: teres major, Medial Triceps long head, Lateral humerus (medial border). Axillary nerve, posterior circumflex artery, humeral artery

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17
Q

Axillary artery branches

A

Divided by pectoralis minor into 3 parts

Screw - superior thoracic artery this medial to pectorals minor

Behind pec minor
The - Thoracoacromial
Lawyer - Lateral Thoracic

Lateral to pectoralis minor
Save - Subscapular
A - anterior humeral circumflex artery
Patient - Posterior humeral circumflex artery

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18
Q

What nerve is damaged during shoulder disclocation

A

axillary nerve
deltoid movement

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19
Q

where is coracoid located

A

2cm below the junction of intermedicate 1/3 and lateral 1/3 clavicle

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20
Q

Factors decreasing the stability of the shoulder joint?

A

shallow glenoid cavity. Lax capsile with few ligaments, inferior aspect is not supported due to the presence of quadrangular space.

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21
Q

what additional movement to aheive full abduction

A

external rotation

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22
Q

Upper limb reflexes
s1-2, L3-4, C5-6, C7-8

A

S1-2 ankle -buckle my shoe, L3-4 - knee Kick the door.
C5-6 pick up sticks - biceps and brachioradialis
C7-8 Shut the gate - Triceps

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23
Q

what goes through radial groove and is affected

A

radial nerve - weak grip
Profund Brachii vessels

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24
Q

what attaches to radial tuberosity

A

biceps brachii

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25
what muscles flex elbow joint
biceps. brachialis, brachioradialis, pronator ters, flexor carpi radialis
26
how would you clinically look if you have an injury at the spinal groove
Paralysis of wrist extensors - wrist drop, paralysis of finger extensors -> finger drop, loss of sensation in the 1st web space
27
what injurie sare seen in supracondylar fracture of the humerus
Brachial artery injury - absent distal pulse Anterior interosseus injury - unable to flex the IP joints of thimb and DIP of index finger Ulnar nerve injury claw hand Radial nerve injur - wrist drop and finger drop
28
Biceps brachii origin insertion action innervation
Coracoid - short head supraglenoid - long head insertion: radial tuberosity supination/flexion musculocutanous nerve
29
30
What innervates the pectoralis major
Medial and lateral pectoral nerves Addict and medically rotate the humerus Scapula anteriorly and inferiority
31
How can you get klumpke
Shoulder dystocia Abduction traction injury
32
What nerve is most likely to be damaged dying mid shaft humerus fracture What happens
Radial nerve Wrist drop loss of extensors Loss of sensation in the 1st dorsal webspaxe Triceps spares
33
What happens when ulnar nerve is damaged at the wrist
calwing of the 4/5th digits loss of sensation medial 1/3 of palm and dorsum of hand and fingers.
34
Where does the flexor retinaculum attach
Proximal to the pisiform and the tubercular of the scaphoid Distal to the hook of hamate and the trapezium
35
What makes up the elbow joint
Distal humerus proximal radius and ulna Surface markings are lateral and medial epicondyles and election fossa 3 articulations Humeri radial ball and socket Humero ulnar hinge joint Superior radio ulnar pivot joint
36
Whic muscles are responsible for flexing of elbow
Biceps brachi Brachailis Brachioradialis
37
Borders of antecubital fossa
Medial border is lateral border of pronator teres Lateral border medial border of brachioradialis Superior border imaginary line between 2 epicondyles Floor brachialis and supinator Roof fascia and bicipital onerous
38
Contents of antecubital fossa
Brachial artery Brachial tendon Median nerve
39
How can the median nerve be damaged
Supracodylar fractures Ulnar nerve also at risk due to being behind medial epicondyles
40
How many compartments of the forearm
anterior Superficial - pronator teres, flexor carpii radialis, flexor digitorum superficialis, palmaris longus, flexor carpi ulnaris Deep - flexor pollicis longus, flexor digitorum profundus, pronator quadratus posterior superficial - extensor carpi ulnaris and aconeus intermediate - extensor digitorum communis and extensor digitor minimi Deep - abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis and supinator mobile wad
41
actions of FDP + FDS
FDP - base of the distal phalanx - flexes proximal IPJ FDS - base of middle phalanx - flexes at the distal IPJ
41
How would you relieve raised compartmental pressures in the forearm
volar incision along ulnar border Dorsal incision lateral epicondyle of humerus to mid wrist
42
Path of the ulnar nerve in the forearm
passes behind the medial epicondyle of the distal humerus before passing between 2 heads of flexor carpi ulnaris to enter the anterior compartment of the forearm and run alongside the ulnar. Gives off 3 branches: dorsal cutaneous/palmar cutaneous/muscular Muscular branch supplies ulnar half of FDP and flexor carpi ulnaris. ulnar nerve joins the ulnar artery to pass deep to the flexor carpi ulnaris before travelling through the Guyon canal at the wrist.
43
can you describe the nervous supply to the muscles of the forearm
flexor median nerve except FCU and half od FDP extensor - radial
44
main sites of venepuncture
median cubital vein antecubital fossa cephalic vein at wrist
45
Boundaries if anatomical snuubox and contents
base bones - 1st metacarpla/trapezium/scaphoid medial - extensor pollicis longus lateral - extensor pollicis brevis and abductor pollicis liongus roof - fascia and skin contents - radial artery/ radial nerve/ cephalic veinq
46
what do lumbricals do
flexion MCPJs Extension IPJs
47
what mechanisms prevent bow stringing of flexor tendons
several pulleys - thickenings of fascia anchoring the flexor tendons to the bony skeletons and allowing smooth sliding beneath Proximally at the writs there os flexor retinaculum and distally there are 5 annular pulley adn 3 cruciate pulleus
48
how many compartments in extensor reticalum and what is it
Triangular aponeurosis in the dorsum of fingers by which extensor tendons insert into the phalanges 6 EPB nad abductor poll longus 2. ECR longus and brecis 3. Ext poll longus 4. ext indicis prop and ext digi 5. ext did minimi 6. ext carpi ulnaris
49
what muscles does musculocutnaeous nerve supply
Bicpes brachi Brachioradilais Coracobrachialis
50
how would a median nerve injur lokk
ape like hand hyperextended thumb adducted thumb flat thenar eminence lateral 2/3 of palm and lateral 3 1/2 digits
51
what is ulnar paradox
clawing is less half of FDP paralysed which will decrease the flexion of IP joints
52
what are the stabilisers of synovial joints in general
static restrains: structures that provide unidirectional limitations to translation glenoid labrim articular version articular conformity negative intraarticular pressure capsule - posterior capsule and rotator interval glenohumeral ligaments dynamic restraints joint concavity compression produced by synchronised contraction of the rotator cudd, acting to stabilise the humeral head within the glenoid; increased capsular tension produced by direct attachments of the rotator cudd to the capsule; the scapular stabilisers that act to mainatin a stable glenoid platform and proprioception
53
what are the main stabilisers of the shoulder joint
rotator cuff muscles
54
role of pectoralis major additional function
adduction and meidal rotation of the arm clavicular head: flexion of the arm sternocostal head extends the flexed arm additional function - respiratory elevation of ribs
55
content of carpal tunnel
4 tendons fo FDS 4 tendons of FDP tendon of flexor pollicis longus tendon of flexor carpi radialis median nerve
56
complications of scaphoid fracture
avascular necrosis malunion delayed union non union
57
what is listers tubercule
pulley for the tendon of the extensor pollicis longus which wraps around the medial side and takes a 45 degree turn
58
where does the extensor digitorum attach
extensor expansion of middle and distal phalanges fo the 2/3/4/5th fingers
59
1st dorsal interosseus muscles origin insertion action
origin - medial aspect of body of first metacarpal bone and alteral aspect of body of second metacarpal bone. insertion: lateral aspect of base of proximal phalanx and extensor expansion of index finger action - abducts indec finger at MCP joint whilst flexing MCP and extends IP joints of index finger innervation - deep branch of ulnar nerve
60
MRCS part B
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