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Anatomy

Anatomy. Block 1 review. Upper limb. Branches of the brachial plexus. Brachial plexus lesions. Paralysis of the Serratus Anterior(winged scapula ).

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Anatomy

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  1. Anatomy Block 1 review

  2. Upper limb

  3. Branches of the brachial plexus

  4. Brachial plexus lesions

  5. Paralysis of the Serratus Anterior(winged scapula ) • When the serratus anterior is paralyzed owing to injury to the long thoracic nerve, the medial border of the scapula moves laterally and posteriorly away from the thoracic wall, giving the scapula the appearance of a wing. Due to loss of Innervation-long thoracic nerve

  6. Injury of the Accessory Nerve (CN XI) • The primary clinical manifestation of accessory nerve palsy is a marked ipsilateral weakness when the shoulders are elevated (shrugged) against resistance.

  7. Injury to the Axillary Nerve The deltoid is a common site for the intramuscular injection of drugs. The axillary nerve runs transversely under cover of the deltoid at the level of the surgical neck of the humerus. The deltoid atrophies when the axillary nerve (C5 and C6) is severely damaged.

  8. Rotator Cuff Muscles • Four of the scapulohumeral muscles supraspinatus, infraspinatus, teres minor, and subscapularis(referred to as the SITS muscles) are called rotator cuff muscles because they form a musculotendinous rotator cuff around the glenohumeral joint.

  9. Arterial Anastomoses around the Scapula Collateral circulation: Subclavian artery-----Suprascapular artery--------circumflex scapular artery----subscapular artery----axillary artery

  10. Lymphatics All lymphatics from the upper limb drain into lymph nodes in the axilla. The 20-30 axillary nodes are generally divided into five groups on the basis of location 1.humeral (lateral) nodes 2.pectoral (anterior) nodes 3.subscapular (posterior) nodes 4.central nodes 5.apical nodes

  11. Cubital tunnel syndrome The symptoms are very similar to the pain from hitting your funny bone. 

  12. Roof of the fossa : Containing the Median cubital vein. This is a communication between Cephalic And Basillic veins Median Cubital Vein

  13. ANATOMICAL SNUFFBOX • Boundries • Medially • -Extensor pollicislongus tendon • Laterally • Abductor pollicislongus tendon • Extensor pollicisbrevis tendon • Clinical importance • 1- Scaphoid bone • 2- Radial pulsation

  14. Carpal tunnel and structures at the wrist • The carpal tunnel is formed anteriorly at the wrist by a deep arch formed by the carpal bones and the flexor retinaculum.

  15. Movements of thumb

  16. Nerves • The hand is supplied by the ulnar, median, and radial nerves.

  17. Ulnar Canal Syndrome (Guyon Tunnel Syndrome) • Compression of the ulnar nerve may occur at the wrist where it passes between the pisiform and the hook of the hamate.

  18. Superficial branch of the radial nerve

  19. Subluxation and Dislocation of Radial Head Pulled elbow or Nursemaid's elbow The sudden pulling of the upper limb tears the distal attachment of the anular ligament, where it is loosely attached to the neck of the radius.

  20. 1 • A 29-year-old man comes in with a stab wound, cannot raise his arm above horizontal, and exhibits a condition known as winged scapula.• Which of the following structures of the brachial plexus would most likely be damaged? • (A) Medial cord • (B) Posterior cord • (C) Lower trunk • (D) Roots • (E) Upper trunk

  21. 2 • A 21-year-old woman walks in with a shoulder and arm injury after falling during horseback riding. Examination indicates that she cannot adduct her arm because of paralysis of which of the following muscles? • (A) Teres minor • (B) Supraspinatus • (C) Latissimusdorsi • (D) Infraspinatus • (E) Serratus anterior

  22. 3 • An 18-year-old boy involved in an automobile accident presents with arm that cannot abduct. His paralysis is caused by damage to which of the following nerves? • (A) Suprascapular and axillary • (B) Thoracodorsal and upper subscapular • (C) Axillary and musculocutaneous • (D) Radial and lower subscapular • (E) Suprascapular and dorsal scapular

  23. 4 • A patient has a torn rotator cuff of the shoulder joint as the result of an automobile accident. Which of the following muscle tendons is intact and has normal function? • (A) Supraspinatus • (B) Subscapularis • (C) Teres major • (D) Teres minor • (E) Infraspinatus

  24. 5 • A patient bleeding from the shoulder secondary to a knife wound is in fair condition because there is vascular anastomosis around the shoulder. Which of the following arteries is most likely a direct branch of the subclavian artery that is involved in the anastomosis? • (A) Dorsal scapular artery • (B) Thoracoacromial artery • (C) Circumflex scapular artery • (D) Transverse cervical artery • (E) Suprascapular artery

  25. Lower limb

  26. great saphenous vein Formed by the union of the dorsal vein of the great toe and the dorsal venous arch of the foot. Ascends anterior to the medial malleolus. Passes posterior to the medial condyle of the femur

  27. The contents of the femoral triangle, from lateral to medial • Femoral nerveand its (terminal) branches. • Femoral sheath and its contents: • Femoral artery • Femoral vein • Deep inguinal lymph nodes • NAVaL(Lateral to medial)

  28. Positive Trendelenburg's sign • If right gluteus medius and minimus muscles are paralyzed, the unsupported left side of the pelvis falls (sags) instead of rising; normally, the pelvis rises.

  29. Injury to common fibular nerve • Footdrop and loss of eversion • May cause sensory loss over lateral leg and dorsum of foot • Causes • Direct trauma as nerve passes superficially around neck of fibula

  30. Contents of Tarsal tunnel Structures That Pass Behind the Medial Malleolus Beneath the Flexor Retinaculum From Medial to Lateral 1.Tibialis posterior tendon 2.Flexor digitorumlongus 3.Posterior tibial artery 4.Tibial nerve 5.Flexor hallucislongus ( TOM DICK AND HARRY)

  31. Avscular Necrosis of head • More common >60 years • In female for osteoporosis • Supplied mainly by Medial circumflex femoral artery by its retinacular branches • Blood supplied through round ligament of femur(br. Of Obturator) is grossly inadequate.

  32. KNEE JOINT

  33. Unhappy triad(TCL,MEDIAL MENISCUS AND ACL)

  34. Ankle Injuries • The lateral ligament is injured because it is much weaker than the medial ligament. • The anterior talofibular ligament part of the lateral ligament is most vulnerable and most commonly torn during ankle sprains.

  35. 1 • During a sports medicine physical by a local family physician, a young woman is tested for stability of her joints before try-outs for the high school team. Which of the following ligaments is important in preventing forward displacement of the femur on the tibia when the weight-bearing knee is flexed? • Medial meniscus • Tibial collateral ligament • Fibular collateral ligament • Posterior cruciate ligament • Anterior cruciate ligament

  36. 2 • A patient arrives at the emergency department with a knife blade embedded in his gluteal region. Radiographic examination reveals that the tip of the knife is against the upper border of the greater sciatic foramen. Which of the following nerves is most likely to have been injured? • Inferior gluteal • Obturator • Pudendal • Sciatic • Superior gluteal

  37. Thorax

  38. breast • Relations of Breast • Blood vessels • Lymphatic drainage

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