– static stabilizers of the shoulder: capsuloligamentous, articular surfaces, and the negative intra-articular pressure components. Dynamic stabilizers include the rotator cuff, biceps tendon, deltoid
– quadrangular space: teres minor, teres major, long head triceps, humeral shaft – axillary nerve and posterior circumflex humeral artery (at the front, you don’t see teres minor – the superior border is subscap)
– triangular interval: not really a space per se – radial nerve and profundi brachii
– triangular space: teres minor, teres major, long head of triceps – circumflex scapular goes through it
– rotator cuff is basically C5/6
– the omohyoid muscles lies anterior to anterior scalene muscle (which lies anterior to the brachial plexus)
– the suprascapular nerve and nerve to subclavius come off of the upper trunk
– the long thoracic nerve and dorsal scapular nerve come off the roots (look for them to tell you if the brachial plexus lesion is pre or post-ganglionic)
– acute brachial neuritis is characterized by acute onset of severe pain, which decreases dramatically over several weeks. Etiology unknown. Present with patchy neurologic findings in C5-T1 distribution. Motor weakness predominates over sensory change. Consider this diagnosis if the clinical picture is abit confusing, with various parts of the plexus affected.
– the elbow MCL – both the anterior and posterior bands are tight in flexion; the capsule is also tight in flexion.
– the nerves most apt to get bagged when doing posterior iliac crest grafting – cluneal (more than 8 cm from PSIS);
– anterior vertebral artery insufficiency – anterior cord syndrome: motor and temp/pain sensation; dorsal columns intact
– the superior thyroid artery may get in your way doing a C4-5 approach; the inferior thyroid artery is more around the C6-7 region.
– C6 quad: no function in FDS
– Tendon transfers for tetraplegic hand – the order of innervation goes:
first: deltoid (C4,5), then biceps
4. Pronator teres
6. finger extensors
7. thumb extensors
8. partial digital flexors
– C5 – ?
– C5/6 – deltoid
– C6 – deltoid, biceps, brachioradialis, ECRL, ECRB, pronator
– C7 – deltoid, biceps, brachioradialis, ECRL, ECRB, pronator, FCR, triceps
– C8 – deltoid, biceps, brachioradialis, ECRL, ECRB, pronator, FCR, triceps, finger extension, thumb extension, finger flexion
– T1 – all of the above plus intrinsics.
– the spinal cord begins embrylogically down at around L3/4, but by full term neonate it is at L1
– landmark for the posterior approach of the knee – medial sural cutaneous nerve and small saphenous vein.
– the Bruser lateral approach to the knee – flex the knee maximally and make a transverse incision over the lateral meniscus; endangers the lateral inferior geniculate artery
– the tibial and femoral insertions of the ACL – the femoral is stronger (??)
– outer wall of a myelomeningocele: epidermis
– the supraclavicular block for the brachial plexus would be performed between the anterior and middle scalene muscles (the plexus comes out from between the two.)
– if you get stabbed in the neck and lose pec major completely – you’ve lost all 5 nerves (C5-T1). The lateral pectoral nerve comes off the lateral cord, the medial from the medial cord. The clavicular head of pec major is mainly innervated by C5 and C6 in particular. The sternocostal head is mainly C7 and C7, and some T1.
– the subclavian vein is anterior to the artery
– Horner’s syndrome – myosis, ptosis, anhidrosis – from first rib fracture, T1 root avulsion, stellate ganglion disruption. An injury to the white rami communicantis of T1 does not cause a Horners.
– Artery of Adamkowitz – Left T9-L2 in most cases.
– medial cord, brachial plexus – gives off axillary and radial nerves, and the upper and lower subscapular nerves, and the thoracodorsal nerve.
– posterior approach to shoulder – muscle splitting