Mbbs2 Shoulder

Front 1

Dermatomes of upper limb - describe where you would test for each one:

Back 1

C3 - Shoulder tip
C4 - Front/back shoulder
C5 - Sergeant's patch
C6 - Thumb (runs over lateral forearm)
C7 - Index finger (also covers palm)

C8 - Little finger (and medial wrist)
T1 - Medial forearm
T2 - Axilla (also medial arm)

Front 2

What cutaneous nerve supplies the shoulder?

Back 2

Supraclavicular Nerve (C3 and C4)

Front 3

How do you remember the names of the cutaneous nerves of the upper limb?

Back 3

They are named by the area they supply:
Posterior cutaneous nerve of arm
Posterior cutaneous nerve of forearm
Palmer branches to palm of hand
Dorsal branches to back of hand

Front 4

Which cutaneous nerve supplies the armpit?

Back 4

Intercostobrachial nerve (T2)

Front 5

Describe the myotomes of the upper limb:

Back 5

Shoulder abduct/lat rotate - C5
Shoulder adduct/med rotate - C6,7,8
Elbow flexion - C5,6
Elbow extension - C7,8
Forearm pronation - C7,8
Forearm supination - C6
Wrist flexion and extension - C6,7
Finger flexion and extension - C7,8
Hand - C8, T1

Front 6

What nerves do the bicep and tricep tendon jerk test?

Back 6

Bicep jerk - C5/6
Tricep jerk - C7,8

Front 7

What nerves come from C5 before it becomes the superior trunk?

Back 7

Dorsal scapular to Levaetor Scapulae and the Rhomboids

Front 8

Which nerves branch off the superior trunk of C5,6?

Back 8

Nerve to Subclavius and Suprascapular

Front 9

Which nerves comes from the lateral cord C5,6,7?

Back 9

Lateral Pectoral, and Musculocutaneous nerves

Front 10

Which nerve comes from the roots of C5,6,7?

Back 10

Long Thoracic (to Serratus Anterior)

Front 11

Which nerves come from the posterior cord?

Back 11

Proximal to distal - Upper Subscapular, Thoracodorsal and Lower Subscapular

Front 12

Which nerves come from the medial cord?

Back 12

Proximal to distal - Medial pectoral, Medial brachial, and Medial Antebrachial

Front 13

Which two major nerves branch from the posterior cord?

Back 13

Axillary (C5,6) and Radial (C5-T1)

Front 14

Which major nerve arises from the joining of the medial and lateral cords?

Back 14

Median nerve (C5-T1)

Front 15

Which major nerve arises solely from the medial cord?

Back 15

Ulnar nerve (C8-T1)

Front 16

Which nerves arise from the medial cord C8,T1?

Back 16

Distally - Medial antebrachial
Proximally - Medial pectoral
In between - Medial brachial

Front 17

Describe Erb Duchenne's palsy:

Back 17

Damage to upper roots (C5,6) - Fall, childbirth, backpacks. Waiter's tip.

Front 18

Describe injury to lower brachial roots

Back 18

Klumpke's paralysis (Ulnar nerve palsy). Decorators or breaking a fall on a tree. Claw.

Front 19

Describe an injury to upper brachial roots

Back 19

Erb Duchenne's palsy - waiter's tip

Front 20

Describe Klumpke's paralysis:

Back 20

Lower brachial roots damaged. Claw.

Front 21

Name the branches from the divisions of the brachial plexus

Back 21

There are none! (lol) (rofl) (pmsl)

Front 22

What nerve supplies serratus anterior?

Back 22

Long thoracic from C5,6,7

Front 23

Which nerves supply subscapularis?

Back 23

Upper and lower subscapular nerves (from the posterior cord)

Front 24

Which nerve supplies teres major?

Back 24

Lower subscapular nerve

Front 25

What muscle does the thoracodorsal nerve supply and what is it's origin?

Back 25

Latissimus dorsi. Arises from the posterior cord, between the upper and lower subscapular nerves. Spinal roots (C7,8)

Front 26

Describe symptoms of a lesion to the long thoracic nerve?

Back 26

Winged scapular, as the long thoracic supplies serratus anterior

Front 27

The Axillary nerve is vulnerable to injury at what point?

Back 27

Fracture of surgical neck of the humerus, or dislocation of the glenohumeral joint

Front 28

The radial nerve is susceptible to injury at what point?

Back 28

The spiral groove on the posterior aspect of the humerus

Front 29

Which nerve might be damaged by an injury to the pisiform in the wrist?

Back 29

The ulnar nerve - it runs lateral to the pisiform

Front 30

How might you acquire an ulnar nerve palsy?

Back 30

Injury to the pisiform bone, or compression on the medial epicondyle of the humerus

Front 31

Which nerve is damaged in carpal tunnel syndrome?

Back 31

The median nerve

Front 32

What is the origin, course and distribution of the axillary nerve?

Back 32

C5,6 spinal roots.Terminal branch of the posterior cord. Supplies deltoid, teres minor and the sergeants patch.

Front 33

What demarks the quadrilateral space in the shoulder?

Back 33

Medially - Long head of triceps
Laterally - Shaft of humerus
Superiorly - Teres minor
Inferiorly - Teres major

Front 34

What is the origin, course and distribution of the radial nerve?

Back 34

C5-C8 spinal roots, posterior cord. Found in the cubital fossa. Supplies brachioradialis, ECRL, MCP joints and the wrist. Gives interosseous nerves.

Front 35

What symptoms might you expect from radial nerve damage?

Back 35

Wrist drop and parasthesia over lateral dorsum of hand

Front 36

What is the origin, course and distribution of the musculocutaneous nerve?

Back 36

C5,6 spinal roots, lateral cord. Arm flexors: Biceps, Coracobrachialis and Brachialis plus lateral skin of forearm.

Front 37

What is the origin, course and distribution of the Ulnar nerve?

Back 37

C7,8 and T1 roots, medial cord. Passes through Guyon's canal. Motor to flexor carpi ulnaris and FDP and small muscles of hand (not thumb). Sensory to little finger.

Front 38

What are the symptoms of an ulnar nerve palsy?

Back 38

Loss of flexion in fingers, weakness of flexion in little finger - Claw hand.

Front 39

What is the origin, course and distribution of the Median nerve?

Back 39

C5-T1, lateral and medial cords. Runs in Cubital Fossa and Carpal Tunnel. Forearm flexors. Sensory to the palm and first three fingers, motor to thumb.

Front 40

Describe a Median nerve palsy

Back 40

Pen test - back of hand flat on table and ask patient to touch a pen held above with their thumb (abduction)

Front 41

Why would you measure Creatinine Kinase?

Back 41

Enzyme is an indicator of muscle cell activity, and is raised in muscle damage (e.g. heart attack, muscle atrophy)

Front 42

Why would you measure the Erythrocyte Sedimentation Rate?

Back 42

Red blood cells aggregate in infection and inflammation, a high ESR is an indicator of this.

Front 43

What muscles make the rotator cuff?

Back 43

Subscapularis, Infraspinatus, Teres Minor and Supraspinatus

Front 44

What are the side effects of steroid treatments?

Back 44

Weight gain, thin skin, osteoporosis, muscle wasting, poor wound healing, infections, diabetes, oedema, hypertension

Front 45

What are the names of the veins in the anterior arm and how to they lie?

Back 45

Cephalic, lateral. Basilic, medial.

Front 46

Describe the blood supply to the arm

Back 46

Subclavian artery becomes Axillary after 1st rib. Then after Teres Major becomes Brachial. Gives profunda brachii. Gives Ulnar and Radial arteries in forearm and arches in the hand.

Front 47

What are the contents of the axillary sheath?

Back 47

Axillary artery, vein and brachial plexus

Front 48

Which muscles/ligaments attach to the medial end of the clavicle?

Back 48

Superiorly, Sternocleidomastoid, Anteriorly, Pec Major, Inferiorly, Costo-clavicular ligament

Front 49

Which muscles/ligaments attach to the lateral end of the clavicle?

Back 49

Deltoid anteriorly, Trapezius posteriorly.

Front 50

Which muscle attaches to the inferior aspect of the clavicle?

Back 50

Subclavius.

Front 51

Does the sterno-clavicular joint contain a capsule?

Back 51

Yes.

Front 52

Which muscles move the sterno-clavicular joint?

Back 52

Protraction - Serratus anterior
Retraction - Trapezius & rhomboids
Elevation - Trapezius, sternocleidomastoid, levaetor scapulae, rhomboids
Depression - Pec Major and subclavius

Front 53

What is the name of the bump and the groove on the bottom of the humerus?

Back 53

Bump = Capitulum (lateral), Groove = Trochlear (medial)

Front 54

Which muscles insert onto the greater tubercle of the humerus and in what order?

Back 54

Superiorly, Supraspinatus
Middle, Infraspinatus
Inferiorly, Teres Minor

Front 55

Which two muscles originate on the inferior border of the Scapular?

Back 55

Teres Minor, superiorly, Teres Major, inferiorly.

Front 56

Which two muscles originate on the medial border of the scapular?

Back 56

Rhomboid minor, superiorly. Rhomboid major, inferiorly.

Front 57

Where does teres major insert?

Back 57

Medial part of bicipital groove
(Pec Major inserts laterally, with Latissimus Dorsi in between)

Front 58

Which muscle inserts onto the lesser tubercle of the humerus?

Back 58

Subscapularis

Front 59

Which muscle originates on the anterior medial aspect of the scapular?

Back 59

Serratus anterior

Front 60

What is the origin, insertion and nerve supply of pec major?

Back 60

Originates on the clavicle, and the lateral border of the sternum and inserts onto the lateral margin of the bicipital groove. Nerve supply is Medial and Lateral pectoral nerve (Lat = Lateral cord, Med = Medial cord)

Front 61

What is the origin, insertion and nerve supply of pec minor?

Back 61

Originates on the 3rd, 4th and 5th ribs, inserts onto the corocoid process of the scapular. Nerve is Medial pectoral only.

Front 62

Which muscle tendon inserts into the glenohumeral joint?

Back 62

Long head of biceps (attaches to supraglenoid tubercle)

Front 63

Which muscle tendon inserts onto the infraglenoid tubercle?

Back 63

Long head of triceps

Front 64

Where are the glenoid tubercles located?

Back 64

Supraglenoid tubercle = inside capsule
Infraglenoid tubercle = outside capsule

Front 65

Which three muscles insert onto the corocoid process?

Back 65

Short head of biceps, coracobrachialis and pec minor

Front 66

Which nerve innervates the arm flexors and what muscles are they?

Back 66

Biceps brachii, coracobrachialis and brachialis - all innervated by Musculocutaneous

Front 67

What two things run in the spiral groove?

Back 67

Radial nerve and profunda brachii artery

Front 68

What are the origins, insertion and innervation of triceps brachii?

Back 68

Long head - Infraglenoid tubercle
Lateral head - Spiral groove to greater tubercle
Medial head - Spiral groove and medial septum
Inserts onto Olecranon Process of the Ulna
Innervated by Radial nerve.

Front 69

What are the origins, insertion and innervation of anconeus?

Back 69

Originates on lateral epicondyle of Humerus, inserts onto Olecranon process of Ulna. Innervated by the Radial nerve.

Front 70

What are the intrinsic ligaments of the proximal radio-ulnar joint?

Back 70

Annular and quadrate ligaments.

Front 71

Define the cubital fossa

Back 71

Proximal - Line joining epicondyles of humerus
Medially - Pronator Teres
Laterally - Brachioradialis
Floor - Brachialis and Supinator

Front 72

What is in the cubital fossa?

Back 72

Lateral to medial -
Radial Nerve
Tendon of Biceps Brachii
Brachial Artery
Median Nerve

Front 73

What does the capitulum articulate with?

Back 73

Head of the radius

Front 74

What does the trochlear articulate with?

Back 74

Ulna

Front 75

What are the bones of the hand?

Back 75

Some Lovers Try Positions That They Cannot Handle
Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate

Front 76

Which muscles pronate the forearm?

Back 76

Brachioradialis, Pronator Teres and Pronator Quadratus.

Front 77

Which muscles supinate the forearm?

Back 77

Supinator (supplied by Radial nerve)

Front 78

Name the 4 superficial and 3 deep muscles in the anterior forearm

Back 78

Superficial:
Pronator Teres, Flexor Carpi Radialis, Palmaris Longus, Flexor Digitorum Superficialis, Flexor Carpi Ulnaris
Deep: Flexor Carpi Profundus, Flexor Pollicis Longus and Pronator Quadratus

Front 79

Where is the common flexor origin and which muscles originate there?

Back 79

Anterior, medial epicondyle
Flexor Carpi Radialis, Flexor Digitorum Superficialis, Palmaris Longus, Flexor Carpi Ulnaris,

Front 80

Physiological state affects absorption of calcium for who?

Back 80

Pregnancy, childhood growth and lactation requires high calcium. As you grow older your requirement decreases.

Front 81

What dietary components boost calcium absorption, and what reduces it?

Back 81

Amino acids, lactose and vitamin D all boost Ca2+ uptake.
Fibre reduces it.

Front 82

What is a typical plasma calcium concentration and how is this stored?

Back 82

2.2-2.6mM - 1.2mM free form, 1 bound to plasma proteins, some (0.3?) in Citrate complexes.

Front 83

Which hormones affect plasma Ca2+ concentrations and how?

Back 83

PTH - Raises plasma Ca2+, lowers plasma Pi
Vit D - Raises plasma Ca2+, raises plasma Pi
Calcitonin - Lowers plasma Ca2+, lowers plasma Pi

Front 84

Where is PTH stored and why is it released?

Back 84

Stored in the parathyroid gland, and released when plasma Ca2+ is low.

Front 85

How is PTH secreted?

Back 85

Low plasma Ca2+ detected by parathyroid calcium receptors, they release Adenocyclase, which raises cAMP. At the same time, the inhibition pathway involving Phospholipase C and IP3 is inhibited.

Front 86

How does PTH act on bone?

Back 86

Osteoblasts have receptors for PTH. PTH prevents osteoblasts from laying down new bone, and they release cytokines which stimulate osteoclasts to release Ca2+ into blood.

Front 87

How does PTH act on the kidney?

Back 87

Increases Ca2+ reabsorption, decreases Pi reabsorption so reduces Pi.

Front 88

How is PTH involved in Vitamin D activation?

Back 88

Activates 1-alpha hydroxylase - needed for Vitamin D.

Front 89

Where is calcitonin formed and how does it act?

Back 89

C-cells (parafollicular) of the thyroid.

Front 90

What are the symptoms of Ricketts and how is it treated?

Back 90

Pigeon chest, spinal deformity, bending of long bones. Fish oils, sun exposure.

Front 91

How is vitamin D metabolised?

Back 91

Ingested or absorbed from sunlight. Hydroxylated in liver to 25 form, and again in the kidney to the active 1,25 form

Front 92

How does active vitamin D act in the GI tract?

Back 92

It acts as a steroid hormone, transported to DNA and promotes synthesis of calbindins.
It also acts on cell membranes to increase their permeability to calcium.

Front 93

How does vitamin D act on bone?

Back 93

Vit D receptors only on osteoblasts to promote bone production.

Front 94

What other hormones affect calcium homeostasis?

Back 94

Oestrogen deficiency, testosterone deficiency, glucocorticoids.

Front 95

What is osteomalacia?

Back 95

Bone softening - bone amount is normal but it is weak.