1
Q
MUSCULOSKELTAL SYSTEM
Arm: radiology
A
2
Q
MUSCULOSKELETAL SYSTEM
Forearm: radiology
A
3
Q
MUSCULOSKELETAL SYSTEM
Arm: radiology
A
4
Q
MUSCULOSKELETAL SYSTEM
Muscles of upper limb
A
5
Q
MUSCULOSKELETAL SYSTEM
Carpal Tunnel
A
- fibro-osseous tunnel at ventral wrist
- boundaries
- anterior → flexor retinaculum
- posteior → carpal bones (lunate)
- components
- 9 tendons (flexor digitorum superficial + flexor digitorum profundus + flexor pollicis longus)
- radial + ulnar burses
- median nerve (only)
- no blood vessels
6
Q
MUSCULOSKELETAL SYSTEM
Rotator Cuff
A
- Muscles of glenohumeral joint (SITS)
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
7
Q
MUSCULOSKELETAL SYSTEM
Clinical Correlate: Carpal Tunnel Syndrome
A
- condition that reducts space of carpal tunnel → compression of median nerve
- symptons → median nerve
- atrophy of tenar compartment + ape hand
- sensory loss/numbness of lateral 3+1/2 digits
- not lateral side of the palm (palmar cutaneous branch of the median nerve enters the hand superficial to the flexor retinaculum)
8
Q
MUSCULOSKELETAL SYSTEM
Clinical Correlate: Humerous Head Dislocation
A
- tipically occurs through inferior portion of the capsule
- inferior portion → not reinforced by rotator cuff tendons
- after inferior dislocation → humerous head is pulled superiorly and comes anterior to joint capsule
- nerve injury
- axillary
- radial
9
Q
MUSCULOSKELETAL SYSTEM
Clinical Correlate: rotator cuff lesions
A
- rupture or tear of tendons
- chronic use of the shoulder
- fall with abducted upper limb
- supraspinatus muscle → most frequently damaged
- pain superiorly and anteriorly
- glenohumeral joint abdcution pain
10
Q
MUSCULOSKELETAL SYSTEM
Clinical Correlate: humeral fracture
A
- Surgical Neck
- axillary nerve damaged
- posterior humeral circumflex artery
- Mid-Shaft
- radial groove fracture
- radial nerve
- profunda brachii artery
11
Q
MUSCULOSKELETAL SYSTEM
Clinical Correlate: carpal bones fracture
A
- Scaphoid
- most frequently fractured
- separation of proximal head of the scaphoid
- avascular necrosis of the proximal head
- Lunate
- most commonly dislocated
- anterior dislocation
- compression of median nerve (carpal tunnel syndrome)
- Hamate
- fall of outstretched hand
- fracture the hook of the hamate
- ulnar nerve lesion
12
Q
NERVE SUPPLY
Brachial Plexus: roots
(5)
A
C5 - T1
+
long thoracic nerve
13
Q
NERVE SUPPLY
Brachial Plexus: trunks
(3)
A
Superior
C5 + C6
supraescapular nerve
Middle
C7
Inferior
C8 + T1
14
Q
NERVE SUPPLY
Brachial Plexus: divisions
(2)
A
Anterior
musculocutaneus + median + ulnar
Posterior
radial + axillary
15
Q
NERVE SUPPLY
Brachial Plexus: cords
(3)
A
Lateral
anterior division → superior + middle trunks
Medial
anterior division → inferior trunk
Posterior
posterior division → all trunks
16
Q
NERVE SUPPLY
Brachial Plexus: terminal branches
(5)
A
17
Q
NERVE SUPPLY
Motor innervation: musculocutaneus nerve
A
- C5 - C6
- anterior compartment of arm
- flex elbow + supination (biceps brachii)
18
Q
NERVE SUPPLY
Motor innervation: median nerve
A
- C5 - T1
- forearm → anterior compartment
- except flexor carpi ulnaris + ulnar half of flexor digitorum profundus
- flex wrist + all digits
- pronation
- hand
- thenar compartment → opposition thumb
- central compartment → lumbricals of digits 2 and 3 (flex metacarpophalangeal + interphalangeal)
19
Q
NERVE SUPPLY
Motor innervation: Ulnar nerve
A
- C8 - T1
- Forearm → anterior compartment
- except muscles innervated by median
- flex wrist (weak) + digits 4 and 5
- Hand
- hypotenar compartment
- interossei palmar (adduct digits 2-5)
- interossei dorsal (abduct digits 2-5)
- lumbricals (flex metacarpophalangeal and interphalangeal digits 4 and 5)
- adductor pollicis (adduct thumb)
20
Q
NERVE SUPPLY
Motor innervation: radial nerve
A
- C5 - T1
- Posterior compartment
- arm → extend elbow
- forearm → extend wrist + digitals + supination
21
Q
NERVE SUPPLY
Motor innervation: axillary nerve
A
- C5-C6
- deltoid → abduct shoulder (15-110º)
- teres minor → lateral rotation shoulder
22
Q
NERVE SUPPLY
Motor innervation: segmental innervation
A
proximal-distal gradient
- shoulder → C5-C6
- distal arm + proximal forearm → C6 - C7
- hand → C8 + T1
23
Q
NERVE SUPPLY
Sensory Innervation: shoulder and arm
A
24
Q
NERVE SUPPLY
Sensory Innervation: hand and forearm
A
25
NERVE SUPPLY
Collateral Nerves: Brachial Plexus
* Long Thoracic Nerve (C5,C6,C7 roots)
* Dorsal Scapular Nerve (C5 root)
* Nerve to subclavius (superior trunk)
* Suprascapular Nerve (anterior division of superior trunk)
* Upper and Lower Subscapular Nerves (posterior cord)
* Thoracodorsal Nerve (posterior cord)
* Medial brachial and forebrachial Cutaneous Nerve (medial cord)
* Medial Pectoral Nerve (medial cord)
* Lateral Pectoral Nerve (lateral cord)
26
NERVE SUPPLY
Collateral Nerves
27
NERVE SUPPLY
Clinical Correlate: Upper Brachial Plexus Lesion
* C5 - C6 → axillary + suprascapular + musculocutaneus
* Erb-Duchenne Palsy - "waiter's tip syndrome"
* head-shoulder forcibly separation - accident + birth injury + herniation
* motor
* shoulder: **medial rotation + adduction** (axillary and suprascapular loss + pectolis major and latissimus dorsi compensation)
* forearm: **extention + pronation** (musculocutaneus loss)
* sensory
* **musculocutaneus**
* lateral forearm to base of thumb
28
NERVE SUPPLY
Clinical Correlate: Lower Brachial Plexus Lesion
* C8 - T1 → ulnar + median (hand)
* Klumpke's Paralysis
* upper limb **forcefullly abducted above the head** → birth injury, thoracic outlet syndrome and grabbing an object when falling
* motor
* **claw hand (ulnar) + ape hand (median)**
* horner syndrome in some cases
* sensory → **ulnar** territory
29
NERVE SUPPLY
Clinical Correlate: In lesions of branches of the brachial plexus, motor weakness precedes sensory loss
True or False
**FALSE**
sensory loss precedes motor weakness
30
NERVE SUPPLY
Clinical Correlate: In lesions of branches of the brachial plexus, proximal lesions have more signs
True or False
**TRUE**
31
NERVE SUPPLY
Clinical Correlate: Radial Nerve
* Axilla → saturday night palsy
* motor loss: extension (arm, wrist and digits) + supination
* sensory loss: posterior (arm, forearm, thumb)
* **wrist drop**
* Elbow → lateral epicondyle // radio head
* motor loss: extension (**not elbow**, wrist and digits) + supination
* sensory loss: posterior (forearm and thumb)
* **wrist drop**
* Wrist → laceration
* no motor loss
* sensory loss: dorsal thumb
32
NERVE SUPPLY
Clinical Correlate: Median nerve
* Elbow → supracondilar fracture (humerus)
* motor loss: flexion (ulnar deviation) + pronation + digital flexion (3 lateral digits) + thumb opposition + thenar atrophy
* sensory loss: **lateral hand + palmar surface of lateral 3 + 1/2 digits**
* **ape hand** (thumb opposition) + **hand of benediction** (digital flexion)
* Wrist → carpa tunnel // laceration
* motor loss: thumb opposition + thenar atrophy
* sensory loss: palmar surface of lateral 3 + 1/2 digits
* only **ape hand** (thumb opposition)
33
NERVE SUPPLY
Clinical Correlate: Ulnar nerve
* Causes
* elbow (medial epicondyle)
* wrist (laceration)
* fracture of hook of hamate
* Motor loss
* loss → abdution/adduction digits 2-5 (interossei) + thumb adduction + hypothenar atrophy
* weaknig → interphalangeal 2-5 digits extension + wrist flexion (radial deviation)
* Sensory loss → ulnar territory
* **Claw hand**
34
NERVE SUPPLY
Clinical Correlate: Axillary nerve
* Causes
* surgical neck of humerus fracture
* inferior dislocation of shoulder
* Motor loss → abduction of arm
* Sensory loss → skin over deltoid muscle
35
NERVE SUPPLY
Clinical Correlate: Musculocutaneus nerve
* Motor → loss of elbow flexion + weakness in supination
* Sensory → lateral forearm
36
NERVE SUPPLY
Clinical Correlate: Long Thoracic nerve
* Causes → superficial surface of **serratus anterior** muscle
* radical mastectomy
* stab in lateral chest
* **Winged Scapula**
* Abduction of the arm
37
NERVE SUPPLY
Clinical Correlate: Suprascapular nerve
**SHOULDER**
Loss of abduction 0-15º
(suprascapular muscle)
+
Weakness of lateral rotation
(infraspinatus muscle)
38
VASCULAR SYSTEM
Arterial Supply
39
VASCULAR SYSTEM
Venous Supply
40
VASCULAR SYSTEM
Lymphatic System
41
VASCULAR SYSTEM
Clinical Correlate: axillary lymph nodes
* Groups
* **anterior (pectoral)** - breast
* **posterior (subscapular)** - back
* **lateral** - upper limb (profund)
* **central** - from the three above
* **infraclavicular (deltopectoral)** - upper limb (superficial)
* **apical** - from all the other axillaty nodes
* Importance: breast cancer + metastasis
42
VASCULAR SYSTEM
Clinical Correlate: axillary artery branches
**H**o**T**e**L**-**SPA**
1. (Highest) Superior Thoracic
2. Thoracoacromial
3. Lateral Thoracic
4. Subscapular
5. Anterior Circumflex Humeral
6. Posterior Circumflex Humeral
