A 43 year old man is stabbed outside a nightclub. He suffers a transection of his median nerve just as it leaves the brachial plexus. Which of the following features is least likely to ensue?

A. Ulnar deviation of the wrist B. Complete loss of wrist flexion C. Loss of pronation D. Loss of flexion at the thumb joint E. Inability to oppose the thumb Answer : B

Loss of the median nerve will result in

loss of function of the flexor muscles

Loss of the median nerve will result in loss of function of the flexor muscles. However, .........................will still function

flexor carpi ulnaris will still function and produce ulnar deviation and some residual wrist flexion

High median nerve lesions result in

complete loss of flexion at the thumb joint

The median nerve is formed by the union of

lateral and medial root respectively from the lateral (C5,6,7) and medial (C8 and T1) cords of the brachial plexus

medial root of brachial passes anterior to

third part of the axillary artery

tell the pathway of median nerve: the medial root passes anterior to the third part of the axillary artery. The nerve descends lateral to the brachial artery, crosses to its medial side (usually passing anterior to the artery).

passes deep to the bicipital aponeurosis and the median cubital vein at the elbow.It passes between the 2 heads of the pronator teres muscle, and runs on the deep surface of FDS. At wrist between FDS and FCR deep to Palmaris longus. Then deep to flx reti

Branches of Median Nerve: Upper arm No branches, although the nerve commonly communicates with the musculocutaneous nerve Forearm : PT, FCR, PL, FDS, FPL, FDP (radial half)

Distal forearm: Palmar cutaneous branch Hand (Motor) Motor supply (LOAF):  Lateral 2 lumbricals  Opponens pollicis  Abductor pollicis brevis  Flexor pollicis brevis Hand (Sensory):  Over thumb and lateral 2 ½ fingers

Median nerve damage at wrist:

 e.g. carpal tunnel syndrome  paralysis and wasting of thenar eminence muscles and opponens pollicis (ape hand deformity)  sensory loss to palmar aspect of lateral (radial) 2 ½ fingers

Median nerve damage at elbow:

Damage at elbow, damage at wrist symptom plus:  unable to pronate forearm  weak wrist flexion  ulnar deviation of wrist

Median nerve damage as it just leaves elbow: Anterior interosseous nerve (branch of median nerve)

 results in loss of pronation of forearm and weakness of long flexors of thumb and index finger

A 24 year old man falls and sustains a fracture through his scaphoid bone. From which of the following areas does the scaphoid derive the majority of its blood supply?

A. From its proximal medial border B. From its proximal lateral border C. From its proximal posterior surface D. From the proximal end E. From the distal end Answer: E

The blood supply to the scaphoid enters from

small non articular surface near its distal end

............area is the only part of the scaphoid that is available for the entry of blood vessels

tubercle of scaphoid. It is commonly fractured and avascular necrosis may result.

scaphoid tubercle gives rise to the:

Radial collateral carpal ligament

A 56/M is inserted a PICC line for long term venous access. This is inserted into the basilic vein at the region of the elbow. As the catheter is advanced, into which venous structure is the tip of the catheter most likely to pass from the basilic vein?

A. Subclavian vein B. Axillary vein C. Posterior circumflex humeral vein D.Cephalic vein E. Superior vena cava Answer: B

.................... is encountered prior to the axillary vein while inserting PICC line

The posterior circumflex humeral vein

Venous arch - proximally- distally-

proximally-axillary vein distally-palmar venous arch

section of brachial plexus

Root / trunk/ Division/ cord / branches - randy travis drinks cold beer

superficial branch of ulnar nerve supplies........

medial third of palm and palmar surface of one and half fingers

deep branch of ulnar nerve arises from......

nerve on the flexor retinaculum lateral to pisiform bone

after arising from pisiform bone the deep branch of ulnar nerve passes .........

passes posteriorly between abductor and short flexor of little finger supplying them

The brachial artery begins at

lower boarder of TERES MAJOR as a continuation of axillary artery

brachial artery terminates in

Cubital fossa by branching into radial and ulnar arteries

brachail artery terminates at the level of .........

neck of radius by dividing in to ulnar and radial arteries

A 22 year old falls over and lands on a shard of glass. It penetrates the palmar aspect of his hand, immediately lateral to the pisiform bone. Which of the following structures is most likely to be injured?

Ulnar artery but ulnar nerve can also get damaged

Bones in hand (Number) -Carpel ............. Metacarpel................ Phalanges.................

Carpel 8 - So long to pinki here comes the thumb Metacarpel 5 Phalanges 14

Intrinsic Muscles of hand

7 Interossei - Supplied by ulnar nerve/ 3 palmar-adduct fingers | 4 dorsal- abduct fingers

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MCQ upper limb

MCQ upper limb MRCS part a

Question	Answer
A 43 year old man is stabbed outside a nightclub. He suffers a transection of his median nerve just as it leaves the brachial plexus. Which of the following features is least likely to ensue?	A. Ulnar deviation of the wrist B. Complete loss of wrist flexion C. Loss of pronation D. Loss of flexion at the thumb joint E. Inability to oppose the thumb Answer : B
Loss of the median nerve will result in	loss of function of the flexor muscles
Loss of the median nerve will result in loss of function of the flexor muscles. However, .........................will still function	flexor carpi ulnaris will still function and produce ulnar deviation and some residual wrist flexion
High median nerve lesions result in	complete loss of flexion at the thumb joint
The median nerve is formed by the union of	lateral and medial root respectively from the lateral (C5,6,7) and medial (C8 and T1) cords of the brachial plexus
medial root of brachial passes anterior to	third part of the axillary artery
tell the pathway of median nerve: the medial root passes anterior to the third part of the axillary artery. The nerve descends lateral to the brachial artery, crosses to its medial side (usually passing anterior to the artery).	passes deep to the bicipital aponeurosis and the median cubital vein at the elbow.It passes between the 2 heads of the pronator teres muscle, and runs on the deep surface of FDS. At wrist between FDS and FCR deep to Palmaris longus. Then deep to flx reti
Branches of Median Nerve: Upper arm No branches, although the nerve commonly communicates with the musculocutaneous nerve Forearm : PT, FCR, PL, FDS, FPL, FDP (radial half)	Distal forearm: Palmar cutaneous branch Hand (Motor) Motor supply (LOAF):  Lateral 2 lumbricals  Opponens pollicis  Abductor pollicis brevis  Flexor pollicis brevis Hand (Sensory):  Over thumb and lateral 2 ½ fingers
Median nerve damage at wrist:	 e.g. carpal tunnel syndrome  paralysis and wasting of thenar eminence muscles and opponens pollicis (ape hand deformity)  sensory loss to palmar aspect of lateral (radial) 2 ½ fingers
Median nerve damage at elbow:	Damage at elbow, damage at wrist symptom plus:  unable to pronate forearm  weak wrist flexion  ulnar deviation of wrist
Median nerve damage as it just leaves elbow: Anterior interosseous nerve (branch of median nerve)	 results in loss of pronation of forearm and weakness of long flexors of thumb and index finger
A 24 year old man falls and sustains a fracture through his scaphoid bone. From which of the following areas does the scaphoid derive the majority of its blood supply?	A. From its proximal medial border B. From its proximal lateral border C. From its proximal posterior surface D. From the proximal end E. From the distal end Answer: E
The blood supply to the scaphoid enters from	small non articular surface near its distal end
Transverse fractures through the scaphoid therefore carry a risk of:	non union
......it has a wide convex articular surface with the radius	scaphoid
.......... associated with the trapezium and trapezoid bones.	scaphoid
............area is the only part of the scaphoid that is available for the entry of blood vessels	tubercle of scaphoid. It is commonly fractured and avascular necrosis may result.
scaphoid tubercle gives rise to the:	Radial collateral carpal ligament
A 56/M is inserted a PICC line for long term venous access. This is inserted into the basilic vein at the region of the elbow. As the catheter is advanced, into which venous structure is the tip of the catheter most likely to pass from the basilic vein?	A. Subclavian vein B. Axillary vein C. Posterior circumflex humeral vein D.Cephalic vein E. Superior vena cava Answer: B
.................... is encountered prior to the axillary vein while inserting PICC line	The posterior circumflex humeral vein
................. is the most common site of obstruction of PICC line insertion	Axillary vein
Venous arch - proximally- distally-	proximally-axillary vein distally-palmar venous arch
A 23 year old man is involved in a fight outside a nightclub and sustains a laceration to his right arm. On examination he has lost extension of the fingers in his right hand.	Radial nerve
radial nerve supplies ....	Extensor muscle group
A 40 year old lady trips and falls through a glass door and sustains a severe laceration to her left arm. Amongst her injuries it is noticed that she has lost the ability to adduct the fingers of her left hand.	Ulnar nerve
interossei are supplied by...... nerve	ulnar nerve
A 28 year old rugby player injures his right humerus and on examination is noted to have a minor sensory deficit overlying the point of deltoid insertion into the humerus.	Axillary nerve
Origin of Brachial Plexus	Anterior rami of C5 to T1
section of brachial plexus	Root / trunk/ Division/ cord / branches - randy travis drinks cold beer
root of brachial plexus located in	posterior triangle of neck
root of brachial plexus passes between	scalenus anterior and medius
A 21 year old man is stabbed in the antecubital fossa. A decision is made to surgically explore the wound. At operation the surgeon dissects down onto the brachial artery. A nerve is identified medially, which nerve is it likely to be?	median nerve
A man sustains a laceration between the base of the little finger and wrist. Several weeks after the injury there is loss of thumb adduction power. Which nerve is most likely to have been injured?	Deep ulnar nerve
At ......... ulnar nerve divide into superficial and deep	wrist
superficial branch of ulnar nerve lies deep to ......	palmaris brevis
superficial branch of ulnar nerve supplies........	medial third of palm and palmar surface of one and half fingers
deep branch of ulnar nerve arises from......	nerve on the flexor retinaculum lateral to pisiform bone
after arising from pisiform bone the deep branch of ulnar nerve passes .........	passes posteriorly between abductor and short flexor of little finger supplying them
youtube video on cource of ULNAR NERVE
A 25 year old man is stabbed in the upper arm. The brachial artery is lacerated at the level of the proximal humerus, and is being repaired. A nerve lying immediately lateral to the brachial artery is also lacerated. Which is the nerve most likely to be?	Median nerve
The brachial artery begins at	lower boarder of TERES MAJOR as a continuation of axillary artery
brachial artery terminates in	Cubital fossa by branching into radial and ulnar arteries
brachial artery lies in the upper arm lies closes to median nerve in ......... position	lateral
brachial artery lies in the cubital fossa lies closes to median nerve in ......... position	Median
What is the course of the median nerve relative to the brachial artery in the upper arm?	lateral > anterior > medial
Relations of median nerve to the brachial artery:	Lateral -> Anterior -> Medial
brachail artery terminates at the level of .........	neck of radius by dividing in to ulnar and radial arteries
In the cubital fossa brachail artery is separated from the median cubital vein by	Bicipital aponeurosis
A 22 year old falls over and lands on a shard of glass. It penetrates the palmar aspect of his hand, immediately lateral to the pisiform bone. Which of the following structures is most likely to be injured?	Ulnar artery but ulnar nerve can also get damaged
Bones in hand (Number) -Carpel ............. Metacarpel................ Phalanges.................	Carpel 8 - So long to pinki here comes the thumb Metacarpel 5 Phalanges 14
Intrinsic Muscles of hand	7 Interossei - Supplied by ulnar nerve/ 3 palmar-adduct fingers \| 4 dorsal- abduct fingers
function of lumbricals	Flex MCPJ and extend the IPJ
Lumbricals - origin and insertion	Origin deep flexor tendon and insertion dorsal extensor hood mechanism.
Innnervation of lumbricals	1st and 2nd- median nerve/ 3rd and 4th- deep branch of the ulnar nerve.
Muscle in thenar eminence	Abductor pollicis brevis /Opponens pollicis/ Flexor pollicis brevis
Muscle in hypothenar eminence	Opponens digiti minimi /Flexor digiti minimi brevis /Abductor digiti minimi
A motorcyclist is involved in a road traffic accident. He suffers a complex humeral shaft fracture which is plated. Post operatively he complains of an inability to extend his fingers. Which of the following structures is most likely to have been injured?	Radial nerve
Muscle supplied by radial nerve	BEST: Brachioradialis/ Extensor group/ Supinator/ Triceps
Radial nerve is responsible for innervation of ........	Extensor compartment of the forearm.
Radial nerve continuation of ..........	posterior cord of the brachial plexus (root values C5 to T1)
Radial nerve in axilla lies posterior to ........ on ......	axillary artery on subscapularis, latissimus dorsi, teres major
Radial nerve enters the arm between......	brachial artery and long head of triceps (medial to humerus)
Radial nerve at the distal third of the lateral border of the humerus pierces.....	intermuscular septum and descends in front of the lateral epicondyle.
Radial nerve at the lateral epicondyle it lies deeply between	brachialis and brachioradialis where it divides into superficial and deep terminal branches
Deep branch of the radial nerve crosses the supinator to become .....	Posterior Interosseus nerve
Radial nerve branches (main) supplies	Triceps/ Anconeus/ Brachioradialis/ Extensor carpi radialis
Radial nerve (posterior interosseus branch) supplies	Extensor carpi ulnaris/ Extensor digitorum/Extensor indicis/ Extensor digiti minimi/ Extensor pollicis longus and brevis/ Abductor pollicis longus
Radial nerve (Sensory innervation)	The area of skin supplying the proximal phalanges on the dorsal aspect of the hand is supplied by the radial nerve (this does not apply to the little finger and part of the ring finger)
Radial nerve injured at shoulder - Muscle affected: Effect of paralysis:	Muscle affected: Long head of triceps Effect of paralysis: Minor effects on shoulder stability in abduction
Radial nerve injured at arm - Muscle affected: Effect of paralysis:	Muscle affected: Triceps Effect of paralysis: Loss of elbow extension
Radial nerve injured at Forearm - Muscle affected: Effect of paralysis:	Muscle affected: Supinator/ Brachioradialis /Extensor carpi radialis longus and brevis Effect of paralysis:Weakening of supination of prone hand and elbow flexion in mid prone position
A 48 year old lady is undergoing an axillary node clearance for breast cancer. Which of the structures listed below are most likely to be encountered during the axillary dissection?	Thoracodorsal trunk
Beware of damaging the ................. if a latissimus dorsi flap reconstruction is planned	Thoracodorsal trunk
Boundry of Axilla	Medially - Chest wall and Serratus anterior/ Laterally - Humeral head /Floor- Subscapularis Anterior aspect Lateral border of Pectoralis major/ Fascia - Clavipectoral fascia
Long thoracic nerve (of bell)	Derived from C5-7 and passes behind the brachial plexus to enter the axilla
Damage of the long thoracic nerve can occur during ............	Axillary surgery
Damage of the long thoracic nerve can lead to............	Winging of scapula
Thoracodorsal nerve and thoracodorsal trunk innervate..............	Innervate and vascularise lattisimus dorsi
Axillary vein is continuation of...............	basilic vein
Axillary vein becomes ........... at the outer boarder of 1st rib	subclavian vein
..........provides cutaneous sensation to the axillary skin.
53 year old lady is recovering following a difficult mastectomy and axillary nodal clearance for ca breast. She complains of shoulder pain and on examination has winging of the scapula. Loss of innervation to which is most likely underlying cause?	Serratus anterior
Winging of the scapula is most commonly the result of............	long thoracic nerve injury or dysfunction
Damage to the rhomboids may produce	winging of the scapula
Long thoracic nerve derived from	ventral rami of C5, C6, and C7
Long thoracic nerve innervate	seeratus anterior muscle
Winging of Scapula occurs in	1) long thoracic nerve injury 2) Spinal accessory nerve injury (which denervate the trapezius) 3) Dorsal scapular nerve injury
A 23 year old man falls and slips at a nightclub. A shard of glass penetrates the skin at the level of the medial epicondyle, which of the following sequelae is least likely to occur?	Claw like appearance of the hand
Injury to ulnar nerve at ............ produces claw hand	mid to distal forearm
ulnar claw hand when injury at the mid to distal forearm produces	claw hand consisting of flexion of the 4th and 5th interphalangeal joints and extension of the metacarpophalangeal joints.
The ulnar claw hand symptoms are potentiated when	flexor digitorum profundus is not affected, and the clawing is more pronounced.
More proximally sited ulnar nerve lesions produce a...........clinical picture	milder
More proximally sited ulnar nerve lesions produce a milder clinical picture due to .....	simultaneous paralysis of flexor digitorum profundus (ulnar half)
"more proximal level of transection the hand will typically not have a claw like appearance that may be seen following a more distal injury" this is known as?	ulnar paradox
In ulnar paradox which muscle will be affected.....	first dorsal interosseous muscle - as it is supplied by ulnar nerve
Ulnar nerve arises from which level of brachial plexus	C8, T1
Muscle supplied by ulnar nerve	Flexor carpi ulnaris / Flexor digitorum profundus / Flexor digiti minimi /Abductor digiti minimi / Opponens digiti minimi /Adductor pollicis / Interossei muscle /Third and fourth lumbricals /Palmaris brevis
branches of ulnar nerve	articular branch/ palmar cutaneous branch/ Dorsal cutaneous branch/ Superficial branch/ Deep branch
Articular branch of ulnar nerve supplies ........	Flexor carpi ulnaris/ Medial half of the flexor digitorum profundus
Palmar cutaneous branch (Arises near the middle of the forearm) of ulnar nerve supplies ........	Skin on the medial part of the palm
Dorsal cutaneous branch of ulnar nerve supplies ........	Dorsal surface of the medial part of the hand
Superficial branch of ulnar nerve supplies.........	Cutaneous fibres to the anterior surfaces of the medial one and one-half digits
Deep branch of ulnar nerve supplies.........	Hypothenar muscles /All the interosseous muscles /Third and fourth lumbricals/ Adductor pollicis/ Medial head of the flexor pollicis brevis
Ulnar nerve damage at the wrist causes.........	Wasting and paralysis of intrinsic hand muscles (claw hand)/ Wasting and paralysis of hypothenar muscles/ Loss of sensation medial 1 and half fingers
Ulnar nerve damage at the elbow..........	Radial deviation of the wrist/ Clawing less in 3rd and 4th digits
A 43 year old lady is due to undergo an axillary node clearance as part of treatment for carcinoma of the breast. Which of the following fascial layers will be divided during the surgical approach to the axilla?	Clavipectoral fascia
Different nodal stations are.........	level 1 nodes- inferior to pectoralis minor/ level 2 -lies behind it /level 3 -above it
During an axillary node clearance for breast cancer the ..............is incised and this allows access to the ..............	clavipectoral fascia / nodal stations
During a Patey Mastectomy surgeons divide ............... to gain access to ..............	pectoralis minor/ level 3 nodes
sentinel node biopsy (and stronger assistants!) have made ............procedure far less common	patey mastectomy
A 23 year old climber falls and fractures his humerus. The surgeons decide upon a POSTERIOR approach to the middle third of the bone. Which of the following nerves is at greatest risk in this approach?	Radial
An IM nail may be preferred because.......	It avoids the complex dissection needed for direct bone exposure.
Radial nerve originates from which level of brachial plexus?	Continuation of posterior cord of the brachial plexus (root values C5 to T1)
A 42 year old teacher is admitted with a fall. An x-ray confirms a fracture of the surgical neck of the humerus. Which nerve is at risk?	Axillary Nerve
The Axillary nerve winds around the bone at .............	neck of the humerus
The axillary nerve is at risk during ..............	shoulder dislocation
A 32 year old window cleaner is admitted after falling off the roof. He reports that he had slipped off the top of the roof and was able to cling onto the gutter for a few seconds. The patient has Horner's syndrome. Which nerve is at risk?	Brachial Trunks C8-T1 . Patient has a Klumpke's paralysis involving brachial trunks C8-T1.
Clinical features of klumpke's paralysis	Classically there is weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner's syndrome.
klumpke's paralysis occurs as a result of............	traction injuries or during delivery.
A 32 year old rugby player is hit hard on the shoulder during a rough tackle. Clinically his arm is hanging loose on the side. It is pronated and medially rotated. It is due to?	Injury to Brachial Trunks C5-6 (Erbs palsy)
cord of brachial plexus related to ........	axillary artery
Division of brachial plexus related to	apex of axilla
which of the following nerves is responsible for innervation of the triceps muscle (all head)?	Radial
nerve roots and their relexes:	1-2 Ankle (S1-S2) /3-4 Knee (L3-L4) /5-6 Biceps (C5-C6) /7-8 Triceps (C7-C8)
Origin of Triceps	1) Long head- infraglenoid tubercle of the scapula. 2) Lateral head- dorsal surface of the humerus, lateral and proximal to the groove of the radial nerve 3)Medial head- posterior surface of humerus on inferomedial side of the radial groove & IM septa
Blood supply to Triceps	Profunda brachii artery
Insertion of triceps	1) Olecranon process of the ulna. Here the olecranon bursa is between the triceps tendon and olecranon/ 2) Some fibres insert to the deep fascia of the forearm, posterior capsule of the elbow
Action of triceps	Elbow extension. The long head can adduct the humerus and and extend it from a flexed position
Relation of triceps	The radial nerve and profunda brachii vessels lie between the lateral and medial heads
Which of the following muscles inserts onto the lesser tuberosity of the the humerus?	Subscapularis
The muscles of the rotator cuff insert into the greater tuberosity except ................	subscapularis (insert into lesser tuberosity)
waht type of joint is shoulder joint?	Ball and shocket joint
Tendon of long head of biceps arise from...........	supraglenoid tubercle
Tendon of long head of triceps attaches to ........	infraglenoid tubercle
read about fibrous capsule from eMRCS
Flexion of the shoulder Joint - muscle	Anterior part of deltoid/ Pectoralis major/ Biceps/ Coracobrachialis
Extension of the shoulder Joint - muscle	Posterior deltoid /Teres major / Latissimus dorsi
Adduction of shoulder joint - muscle	Pectoralis major/ Latissimus dorsi/ Teres major/ Coracobrachialis
Abduction of shoulder joint - muscle	Mid deltoid Supraspinatus
Medial rotation of shoulder joint - muscle	Subscapularis/ Anterior deltoid/ Teres major/ Latissimus dorsi
lateral rotation of shoulder joint - muscle	Posterior deltoid/ Infraspinatus/ Teres minor
(relation) Anterior to shoulder joint	Brachial plexus/ Axillary artery and vein
(relation) posterior to shoulder joint	Suprascapular nerve Suprascapular vessels
(relation) inferior to shoulder joint	Axillary nerve/ Circumflex humeral vessels
which of the following nerves is not contained within the posterior triangle of the neck?	A. Accessory nerve B. Phrenic nerve C. Greater auricular nerve D. Ansa cervicalis E. Lesser occiptal nerve//////// Answer D
Ansa cervicalis is a content of the ............. triangle of the neck.	anterior triangle
boundry of posterior triangle of neck	Apex: Sternocleidomastoid and the Trapezius muscles at the Occipital bone////// Anterior: Posterior border of the Sternocleidomastoid///// Posterior: Anterior border of the Trapezius///////// Base: Middle third of the clavicle
content of posterior triangle of neck	Nerves: Accessory nerve/ Phrenic nerve/ Three trunks of the brachial plexus/ Branches of the cervical plexus: Supraclavicular nerve, transverse cervical nerve, great auricular nerve, lesser occipital nerve
A 73 year old lady suffers a fracture at the surgical neck of the humerus. The decision is made to operate. There are difficulties in reducing the fracture and a vessel lying posterior to the surgical neck is injured. which is most likely vessel?	Posterior circumflex humeral artery
posterior circumflex humeral artery is branch of .........	axillary artery
Which of the structures listed below lies posterior to the carotid sheath at the level of the 6th cervical vertebra?	A. Hypoglossal nerve B. Vagus nerve C. Cervical sympathetic chain D. Ansa cervicalis E. Glossopharyngeal nerve//////////// Answer: C
carotid sheath is crossed anteriorly by:	Hypoglossal nerves and the ansa cervicalis.
right common carotid artery arises from	Bifurcation of the brachiocephalic trunk
left common carotid arises from	Arch of the aorta
Right and left common carotid artery terminate at level of	thyroid cartilage (lower boarder of 3rd cervical vertebra) ---by dividing into internal and external carotid arteries
carotid arteries passes behind .......... to ............	sternoclavicular joint/ upper boarder of thyroid cartilage and divide into - ICA and ECA
Left common carotid artery crossed by.............., Right common carotid artery crossed by...............	left- Thoracic duct/ Right- Recurrent laryngeal nerve
The inferior thyroid artery passes ........... to the common carotid artery.	posterior
carotid tubercle location.............	transverse process 6th cervical vertebra
compression at which region of carotid stops haemorrhage?	carotid tubercle
A 45 year old man presents with a lipoma located posterior to the posterior border of SCM muscle, approximately 4 cm superior to middle third of the clavicle. During surgical excision of lesion troublesome bleeding is encountered. What is likely source?	External jugular vein
external jugular vein runs obliquely in superficial fascia of.......... triangle	posterior
internal jugular vein and carotid arteries are located in ..........triangle	anteriro
third part of subclavian artery is part of ............triangle	posterior
Which of the following upper limb muscles is not innervated by the radial nerve?	A. Extensor carpi ulnaris B. Abductor digit minimi C. Anconeus D. Supinator E. Brachioradialis/////////////////// Answer B
Mnemonic for radial nerve muscles	BEST B rachioradialis - E xtensors - S upinator - T riceps
Abductor digiti minimi is innervated by	Ulnar nerve
Which of the following forms the floor of the anatomical snuffbox	Scaphoid bone
Boundry of anatomical snuffbox	Posterior = Tendon of extensor pollicis longus/ Anterior =Tendons of extensor pollicis brevis and abductor pollicis longus /Proximal= Styloid process of the radius /Distal= Apex of snuffbox triangle/ Floor= Trapezium and scaphoid Content Radial artery
A 32 year old lady complains of carpal tunnel syndrome. The carpal tunnel is explored surgically. Which of the following structures will lie in closest proximity to the hamate bone within the carpal tunnel?	The tendons of flexor digitorum profundus
The carpal tunnel contains...........flexor tendons	nine (Flexor digitorum profundus // Flexor digitorum superficialis // Flexor pollicis longus)
tendon of flexor digitorum profundus lies ........... in carpel tunnel and lie nearest to........... bone	Deepest ///hamate
No tendons attach to which carpel bones:	Scaphoid, lunate, triquetrum
Image of carpel bones
A man presents with hand weakness. He is given piece of paper to hold between his thumb and index F. When paper is pulled, the patient has difficulty maintaining grip. Grip pressure is maintained by flexing thumb at the IP joint. most likely nerve lesion?	Deep branch of ulnar nerve (Describes forments sign= test for ulnar nerve palsy)
forments sign tests function of	adductor pollicis
anterior interosseous branch innervates..........	flexor pollicis longus (hence causing flexion of the thumb IP joint)
Damage at the wrist of ulnar nerve causes	1)Wasting and paralysis of intrinsic hand muscles (claw hand) //////2) Wasting and paralysis of hypothenar muscles//// 3) Loss of sensation medial 1 and half fingers
Damage at the elbow of ulnar nerve causes	1) Radial deviation of the wrist //////// 2)Clawing less in 3rd and 4th digits
10 year old by falls out of tree has suffers supracondylar fracture. He complains of painful elbow and forearm. There is an obvious loss of pincer movement involving the thumb and index finger with minimal loss of sensation. most likely nerve injury is:	Anterior interosseous nerve
The anterior interosseous nerve is a motor branch of.............	median nerve just below the elbow.
Damage to the anterior interosseous nerve causes:	Pain in the forearm / Loss of pincer movement of the thumb and index finger (innervates the long flexor muscles of flexor pollicis longus & FDP of the index and middle finger) /Minimal loss of sensation due to lack of a cutaneous branch
A 32 year old attends neurology clinic complaining of tingling in his hand. He has radial deviation of his wrist and there is mild clawing of his fingers, with the 3rd and 4th digits being relatively spared. What is the most likely lesion?	Ulnar nerve damage at the elbow
At the elbow the ulnar nerve lesion affects..........	flexor carpi ulnaris and flexor digitorum profundus
A 23 year old man is involved in a fight and is stabbed in his upper arm. The ulnar nerve is transected. Which of the following muscles will not demonstrate compromised function as a result?	Pronator teres
Pnemonic for muscle supplied by Ulnar nerve	MAFIA////////////M edial lumbricals/ A dductor pollicis F lexor digitorum profundus/Flexor digiti minimi /I nterossei/ A bductor digiti minimi and opponens
all intrinsic muscles of the hand innervated by ulnar nerve except	thenar muscles & first two lumbricals - supplied by median nerve
Pronator teres is innervated by......	median nerve
Palmaris brevis innervated by......	ulnar nerve
cephalic vein lies.............to biceps	anterolateral
cephalic vein terminates in................	axillary vein
pathway of cephalic vein	Dorsal venous arch drains laterally into cephalic vein //Crosses snuffbox and travels laterally up arm //At antecubital fossa connected to the basilic vein by the median cubital vein// Pierces deep fascia of deltopectoral groove to join axillary vein
Dorsal venous arch drains laterally into	cephalic vein
22 year old man is involved in a fight. Sustains a laceration to posterior aspect of his wrist. In ER laceration is found to be transversely orientated & overlies extensor retinaculum, which is intact.Which of the following is least likely to be injured?	A. Dorsal cutaneous branch of the ulnar nerve B. Tendon of extensor indicis C. Basilic vein D. Superficial branch of the radial nerve E. Cephalic vein///////////// Answer B
extensor retinaculum attaches to the.........	radius proximal to the styloid
The extensor tendons lie............to the extensor retinaculum	deep
The extensor tendons lie deep to the extensor retinaculum so.....	less susceptible to injury than the superficial structures.
Extensor rentinaculum is a thickening of the...............	deep fascia
Attachments of Extensor retinaculum are:	The pisiform and hook of hamate medially  The end of the radius laterally
Structures superficial to the retinaculum	Basilic vein///// Dorsal cutaneous branch of the ulnar nerve////Cephalic vein////Superficial branch of the radial nerve
Structures passing deep to the extensor retinaculum	Extensor carpi ulnaris tendon // Extensor digiti minimi tendon// Extensor digitorum and extensor indicis tendon //Extensor pollicis longus tendon //Extensor carpi radialis longus tendon // Abductor pollicis longus and extensor pollicis brevis tendons
The radial artery passes between	lateral collateral ligament of the wrist joint and the tendons of the abductor pollicis longus and extensor pollicis brevis.
A man has an incision sited than runs 8cm from the deltopectoral groove to the midline. Which of the following is not at risk of injury?	A. Cephalic vein B. Shoulder joint capsule C. Axillary artery D. Pectoralis major E. Trunk of the brachial plexus///////// Answer B
Delto pectoral groove lie medial to ..........	Joint capsule
Pectoralis major (muscle origin insertion nerve supply and action)	Origin: From the medial two thirds of the clavicle, manubrium and sternocostal angle/// Insertion: Crest of the greater tubercle of the humerus ///Nerve supply: Lateral pectoral nerve ///Actions: Adductor and medial rotator of the humerus
A 19 year old student is admitted to A&E after falling off a wall. He is unable to flex his index finger. An x-ray confirms a supracondylar fracture. which nerve is injured?	Median nerve (median nerve is at risk during a supracondylar fracture)
A well toned weight lifter attends clinic reporting weakness of his left arm. There is weakness of flexion and supination of the forearm. Which nerve is involved?	Musculocutaneous nerve
Mucocutaneous nerve compression due to entrapment of the nerve between	biceps and brachialis.
Entrapment of musculocutaneous nerve affects which action?	Elbow flexion and supination of the arm
An 18 year old girl sustains an Holstein-Lewis fracture. Which nerve is at risk?	Radial nerve
what is Holstein-Lewis fractures?	fractures of the distal humerus with radial nerve entrapment. (Proximal lesion affects triceps so clinical features are: paralysis of wrist extensors and forearm supinators occur. Reduced sensation of dorsoradial aspect of hand and dorsal 31/2 fingers)
A 35 year old farm labourer is injures the posterior aspect of his hand with a mechanical scythe. He severs some of his extensor tendons in this injury. How many tunnels lie in the extensor retinaculum that transmit the tendons of the extensor muscles?	six
23 year old man is injured during game of rugby. He suffers fracture of distal third of clavicle, it is compound fracture and there is evidence of arterial haemorrhage. Which vessels is most likely to be encountered first during surgery?	Thoracoacromial artery
thoracoacromial artery arises from	second part of the axillary artery
Thoracoacromial artery pierces the ............fascia	clavipectoral
Thoracoacromial artery ends deep to ................muscle >>> dividing into 4 branches	pectoralis major
Branches of thoracoacromial artery	4 branches: 1) Pectoral // 2) Acromial // 3) Clavicular // 4) Deltoid
Pectoral branch of thoracoacromial artery anastomose with.....	intercostal branches of the internal thoracic artery and with the lateral thoracic
Pectoral branch of thoracoacromial artery give branch to....>>> ends in arterial network formed from suprascapular, thoracoacromial, and posterior humeral circumflex arteries.	deltoid
clavicular branch of thoracoacromial artery supplies.....	sternoclavicular joint and subclavius
Deltoid branch of thoracoacromial artery supplies.....	Deltoid and pectoralis major
68 year old man falls onto an outstretched hand. Following the accident he is examined in the emergency department. On palpating his anatomical snuffbox there is tenderness noted in the base. What is the most likely injury in this scenario?	Scaphoid fracture
...... part of scaphoid receives part of the flexor retinaculum and is the only part of the scaphoid that is available for the entry of blood vessels.	tubercle of scaphoid >> fracture here may result in AVN
Which of the following structures passes through the quadrangular space near the humeral head?	Axillary nerve
quadrangular space near the humeral head is bordered by	humerus = laterally////subscapularis = superiorly///teres major = inferiorly ///long head of triceps = medially.
quadrangular space near the humeral head is .............to triangular space	lateral to
what structure passes through quadrangular space near the humeral head?	Axillary nerve and posterior circumflex humeral artery
Which of the following structures separates the ulnar artery from the median nerve?	Pronator teres
median nerve is in relation with the medial side of the ......artery for about 2.5 cm.	ulnar artery
relation of ulnar artery	Deep to- Pronator teres, Flexor carpi radialis, Palmaris longus ///////Lies on- Brachialis and Flexor digitorum profundus /////////Superficial to the flexor retinaculum at the wrist
branch of ulnar artery	Anterior interosseous artery
32 year old motorcyclist is involved in RTA. His humerus is fractured and severely displaced. At the time of surgical repair the surgeon notes that radial nerve has been injured. Which is least likely to be affected by injury at this site?	A. Extensor carpi radialis brevis B. Brachioradialis C. Abductor pollicis longus D. Extensor pollicis brevis E. None of the above///////// Answer: E
Which muscle is responsible for causing flexion of the interphalangeal joint of the thumb?	Flexor pollicis longus
Muscle that causes flexion of IP joint of thumb	8 muscles: 1. Two flexors FPB and FPL) 2. Two extensors (EPB and EPL) 3. Two abductors (abductor pollicis brevis and longus) 4. One adductor (adductor pollicis) 5. One muscle that opposes the thumb by rotating the CMC joint (opponens pollicis).
Flexor and extensor longus insert on the distal phalanx moves ............joint	MCP and IP joints.
18 year old man is stabbed in the axilla during a fight. His axillary artery is lacerated and repaired. However, the surgeon neglects to repair an associated injury to upper trunk of the brachial plexus. Which of following muscles is least likely to show	Palmar interossei
palmar interossei are supplied by	ulnar nerve
23 year old man is involved in a fight, during dispute he sustains a laceration to the posterior aspect of his right arm, approx 2cm proximal to the olecranon process. In the ER, he is unable to extend his elbow joint. Which tendon is most likely to cut?	Triceps
triceps muscle........... the elbow joint.	extends
Which of the following muscles does not attach to the radius?	A. Pronator quadratus B. Biceps C. Brachioradialis D. Supinator E. Brachialis/////// ANSWER: E
brachialis muscle inserts into	Ulna
Attachments in the radius (learn from picture)
Which of the following is not an intrinsic muscle of the hand?	A. Opponens pollicis B. Palmaris longus C. Flexor pollicis brevis D. Flexor digiti minimi brevis E. Opponens digiti minimi ANSWER: B
Mnemonic for intrinsic hand muscles?	'A OF A OF A' A bductor pollicis brevis /O pponens pollicis/ F lexor pollicis brevis /A dductor pollicis (thenar muscles) /O pponens digiti minimi/ F lexor digiti minimi brevis/ A bductor digiti minimi (hypothenar muscles)
Intrinsic muscle of hand (Rule of 3s)	3 thenar muscle : (Abductor/ Flexor/ Oppones) pollicis// 3 hypothenar muscle: (Abductor/ Flexor/ Oppones) digiti minimi// 3 other muscle: dorsal/palmar - interossei, lumbricals// 3 abductor of digits: dorsal interossei, abductor PB, abductor DM

Created by: sarthaknepal1

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