Y2 OSPE > Upper limb > Flashcards

Upper limb Flashcards

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1
Q

How do you test Sterno-cleido-mastoid

A

turn the head to right or left against resistance (Nerve- spinal accessory, CN XI & C3,4)

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2
Q

How do you test Trapezius

A

raise both shoulders against resistance (Nerve- spinal accessory, CN XI C3,4)

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3
Q

How do you test Pectoralis major

A

adduct the abducted arm against resistance (Nerves-lateral & medial pectoral C5,6,7,8,T1)

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4
Q

How do you test Serratus anterior

A

Ask the patient to push their arm out (protract their shoulder) against your resistance whilst you palpate serratus anterior (Nerve-Long thoracic C5,6)

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5
Q

How do you test Teres major

A

adduct the arm against resistance. See and palpate the muscle in the posterior axillary fold (Nerve-Lower subscapular C5,6)

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6
Q

How do you test Latissimus dorsi

A

Abduct arm to 90 degrees, then adduct against resistance whilst the elbow is flexed. See and palpate the muscle in the posterior axillary fold (Nerve-Thoraco dorsal C6,7,8)

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7
Q

How do you test Deltoid

A

abduct the upper arm against resistance with the arm flexed to 90o at the elbow whilst you palpate the deltoid. (Nerve = axillary C5,6)

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8
Q

What condition arises from damage to the long thoracic nerve?

A

Winging of the scapula

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9
Q

What nerve roots does the triceps reflex test?

A

C7, 8

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10
Q

What are the boundaries of the anatomical snuffbox?

A

Medial border:

  • Tendon of extensor pollicus longus

Lateral border:

  • Tendon of extensor pollicus brevis
  • Tendon of extensor abductor pollicus

Proximal border:

  • Styloid process of radius

Floor:

  • Scaphoid
  • Trapezium
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11
Q

What movement is possible at the scapulo-thoracic joint?

A
  • Protraction
  • Retraction
  • Elevation
  • Depression
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12
Q

What movements are possible at the shoulder joint?

A
  • Flexion/Extension
  • Abduction/Adduction
  • Lateral/Medial rotation
  • Circumduction
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13
Q

What movements are possible at the elbow joint?

A
  • Flexion/Extension
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14
Q

What movements are possible at the Proximal and distal radio-ulnar joints?

A

Pronation/supination

  • Pronation = palm facing the pavement
  • Supination = palm facing the sky
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15
Q

What movements are possible at the wrist joint?

A
  • Flexion/Extension
  • Ulnar/radial deviation
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16
Q

What movements are possible at the carpo-metacarpal joints of the thumb and other fingers?

A
  • 1st joint (thumb) = flexion/etension abduction/adduction opposition/reposition
  • 2nd and 3rd = effectively no movement possible
  • 4th and 5th =
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17
Q

What movements are possible at the metacarpo-phalangeal joints?

A
  • Mainly flexion

To a limited extent can also:

  • Extend
  • Radial deviate
  • Ulnar deviate
  • Circumduct
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18
Q

Why is the wrist joint called the radiocarpal joint?

A
  • Only the radius articulates with the carpal bones (scaphoid, lunate, triquetrum)
  • The ulnar is separated from the carpal bones by the articular disc that stabilises the distal radio-ulnar joint during pronation
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19
Q

What is the carpal tunnel formed of?

A

Carpal bones

Flexor retinaculum

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20
Q

What are the contents of the carpal tunnel?

A
  • 4 tendons of the flexor digitorium profundus
  • 4 tendons of the flexor digitorium superficialis
  • The 1 tendon of flexor pollicus longus
  • Median nerve
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21
Q

What movements are possible at the interphalangeal joints?

A

Flexion (more extensive)

Extension

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22
Q

What nerve and nerve roots innervate serratus anterior?

A

Long thoracic

C5,6

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23
Q

What is the action of pectoralis major?

A

Acts on the humerus to:

  • Adducts
  • Flex
  • Medially rotate
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24
Q

What nerve and nerve roots innervate latissimus dorsi?

A

Thoraco dorsal

C6,7,8

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25
What are the functions of latissimus dorsi?
Acts on the upper limb to: * Extend * Adduct * Medially rotate
26
What are the parts of the trapezius muscle?
From superior to inferior: * Descending * Transverse * Ascending
27
What are the actions of the trapezius?
Acts on the scapula to: * Elevate and rotate * Retract * Depress
28
Which nerve and its spinal roots innervate the trapezius muscle?
spinal accessory, CN XI C3,4
29
What are the actions of serratus anterior?
Acts on the scapula to: * Laterally rotate * Protract against the ribcage
30
How do you test pectoralis major?
1. Apply resistance to the patient adducting their arm whilst their elbow is flexed * Palpate pec major 1. Apply resistance whilst the patient medially rotates their forearm * Palpate pec major 1. Apply resistance whilst the patient flexes their arm at the elbow joint * Palpate pec major
31
What are the actions of deltoid?
Abduct the arm
32
What nerve and nerve root innervates deltoid?
axillary C5,6
33
What nerves innervate the rotator cuff muscles?
1. Subscapularis -upper and lower subscapular nerves 2. Supraspinatus - suprascapular nerve 3. Infraspinatus - suprascapular nerve 4. Teres minor - axilliary nerve
34
What are the actions of the rotator cuff muscles?
1. Subscapularis - Medially rotates the arm 2. Supraspinatus - Main abductor or arm to 15o 3. Infraspinatus - Laterally rotates the arm 4. Teres Minor - Laterally rotates the arm
35
How do you test the rotator cuff muscles?
Apley's scratch test 1. To assess lateral rotation and abduction * Ask the patient to put their hand behind their neck whilst you provide resistance 1. To assess medial rotation (subscapularis) * Ask the patient to put their hand as far up their back as possible starting from the inferior part of their back whilst you provide resistance
36
What are the actions of biceps brachii?
Flexor and supinator of the forearm
37
How do you test biceps brachii?
1. Stabilise the elbow 2. Ask the patient to flex their elbow whilst you provide resistance
38
What are the muscles of the anterior compartment of the arm?
Biceps brachii Brachialis Coracobrachialis
39
What are the muscles in the anterior compartment of the arm innervated by?
Musculocutaneous nerve
40
What are the actions of triceps brachii?
Extension of the forearm and some adduction of the arm
41
What is triceps brachii innervated by?
Radial nerve
42
How do you test the function of triceps brachii?
1. Stabilise the elbow 2. Ask the patient to extend the elbow whilst you provide resistance
43
What are the pronators of the forearm?
Mainly: * Pronator teres * Pronator quadratus Slightly: * Flexor carpi radialis * Palmaris longus * Brachioradialis
44
How do you test the pronators of the forearm?
1. stabilise the elbow 2. hold the patient's hand as if you were shaking their hand 3. ask them to pronate their forearm (pronation is turning the palm to the pavement) whilst you provide resistance
45
What are the pronators of the forearm innervated by?
Pronator teres, pronator quadratus, Flexor carpi radialis and Palmaris longus = median nerve Brachioradialis = radial nerve
46
What are the supinators of the forearm?
Mainly: * Supinator * Biceps Slightly: * Extensor pollicus longus * Extensor carpi radialis longus
47
How do you test the supinators of the forearm?
1. stabilise the elbow 2. hold the patient's hand as if you were shaking their hand 3. ask them to supinate their forearm (supination is turning the palm to the sky) whilst you provide resistance
48
What are the supinators of the forearm innervated by?
* Biceps - musculocutaneous nerve * Supinator - radial * Extensor pollicus longus - median nerve * Extensor carpi radialis longus - radial nerve
49
What are the superficial wrist flexors of the forearm?
Mainly: * Flexor carpi radialis * Flexor carpi ulnaris Slightly: * Palmaris longus
50
How would you test the superficial wrist flexors of the forearm?
1. Ask the patient to flex their elbow and hold it like a boxer 2. Then ask them to pronate their wrist 3. Then ask them to flex their wrist to have their palm facing the floor whilst you provide resistance
51
What innervates the superficial wrist flexors of the forearm?
* Flexor carpi radialis - median * Flexor carpi ulnaris - ulna * Palmaris longus - median
52
What are the muscles of the anterior forearm?
1. Superficial * Pronator teres * Flexor carpi radialis * Flexor carpi ulnaris * Palmaris longus 1. Intermediate * Flexor digitorium superficialis 1. Deep * Flexor digitorium profundus * Pronator quadratus * Flexor pollicus longus
53
What is the action of FDS?
* Flexion of the wrist * Flexes the metacarpophalangeal joints * Flexes the proximal interphalangeal joints
54
What is FDS innervated by?
Median nerve
55
How do you test FDS?
1. Stabilise the joints by grasping the proximal phalanx of all the digits 2. Ask the patient to flex their digits at their proximal interphalangeal joints all at once whilst you provide resistance
56
57
What bone is the subclavian pulse palpated against?
Rib I
58
What bone is the ulnar pulse palpated against?
Head of the ulna
59
What is the superficial venous drainage of the arm?
Cephalic: * From anatomical snuffbox to axilliary vein above pec minor muscle * Lateral to biceps brachii * Radial side Basilic: * Ulnar side * Medial to biceps brachii * Joins the basilic veins to form the axillary vein
60
What are the boundaries of the axilla?
Anteriorly: * pectoralis major and minor Medially: * thoracic wall * serratus anterior Posteriorly: * Subscapularis * Latissimus dorsi * Teres major Laterally: * Intertubercular sulcus of the humerus
61
Where does the flexor retinaculum attach?
Lateral (radial): * Scapphoid * Trapezium Medial (ulnar): * Pisiform * Hook of hamate
62
63
Draw the dermatomes of the arm
64
Draw the cutaneous innervation of the upper limb
65
What nerve roots does the biceps reflex test?
C5,6
66
How would you test the motor component of the musculocutaneous nerve?
Flexion of the forearm
67
How would you test the motor component of the axillary nerve?
Abduction of the arm against resistance
68
How would you test the motor component of the median nerve?
* Wrist flexion * Wrist abduction * Flexion of fingers
69
How would you test the motor component of the radial nerve?
* Extension of elbow joint, wrist joint and metacarpophalangeal joints
70
How would you test the motor component of the Median nerve?
* Adduction and abduction of the digits * Flexion and ulnar deviation at the wrist joint
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