USMLE Step 1 Web Prep — Upper Limb

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Section III Gross Anatomy and Organogenesis
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Upper Limb
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B A!"IAL #LE$US Lesions of t%e Brac%ia& #&e'(s Upper tr(n) *!+, !-. Erb’s paralysis affects axillary, suprascapular, and muscul cutane us ner!es "#i$ure 11%&%1'( ) ss f intrinsic muscles f t*e s* ulder( ) ss f muscles f t*e anteri r arm( +rm is medially r tated and adducted( ,*e f rearm is extended and pr nated( -i$n is ./aiter’s tip(0
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B A!"IAL #LE$US Lesions of t%e Brac%ia& #&e'(s Lo/er tr(n) *!0, 11. ,* racic utlet syndr me( ) ss f all t*e muscles f t*e f rearm and *and( -i$n is c mbinati n f .cla/ *and0 and .ape *and(0 1ay include a 2 rner syndr me(
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1%e 2otor Inner3ation by t%e 4i3e 1ermina& 5er3es 1ermina& 5er3es 2(sc&es Inner3ated 1uscul cutane us ner!e 1edian ner!e +ll t*e muscles f t*e anteri r c mpartment f t*e arm +ll t*e muscles f t*e anteri r c mpartment f t*e f rearm

*e p steri r muscles f t*e arm and f rearm 397835 >>> 00:15:&7 SLIDE 0 of 22 1%e !o&&atera& 5er3es of t%e Brac%ia& #&e'(s !o&&atera& 5er3e 2(sc&es or S)in Inner3ated 7 rsal scapular ner!e ) n$ t* racic ner!e -uprascapular ner!e )ateral pect ral ner!e 1edial pect ral ner!e 6pper subscapular ner!e 8* mb ids -erratus anteri r -upraspinatis and infraspinatus 9ect ralis ma: r 9ect ralis ma: r and min r -ubscapularis 3978&0 >>> 00:1.*e 3 t*enar c mpartment muscles and t*e 1st and 2nd lumbricals 6lnar ner!e . . SLIDE 7 of 22 1%e !o&&atera& 5er3es of t%e Brac%ia& #&e'(s !o&&atera& 5er3e 2(sc&es or S)in Inner3ated 1iddle subscapular "t* rac d rsal' ner!e ) /er subscapular ner!e 1edial brac*ial cutane us ner!e 1edial antebrac*ial cutane us ner!e )atissimus d rsi -ubscapularis and tears ma: r -<in f medial arm -<in f medial f rearm SLIDE 18 of 22 3978&5 >>> 00:17:&.:2.except 131425 muscles "flex r capri ulnaris and t*e ulnar 31425 f t*e flex r di$it rum pr fundus'.*e 1 31425 muscles f t*e f rearm n t inner!ated by t*e median ner!e +ll t*e muscles f t*e *and except t* se inner!ated by t*e median ner!e 397830 >>> 00:15:28 SLIDE 6 of 22 1%e 2otor Inner3ation by t%e 4i3e 1ermina& 5er3es 1ermina& 5er3es 2(sc&es Inner3ated +xillary ner!e 8adial ner!e 7elt id and teres min r .

and *and( -i$n is . f rearm./rist dr p(0 #racture f t*e s*aft f t*e *umerus c uld lacerate t*e radial ner!e. and di$its= /ea<ened extensi n at t*e s* ulder= /ea<ened supinati n( -ens ry l ss n p steri r arm. /rist. pressure n t*e fl r f axilla may in:ure ner!e "-aturday ni$*t palsy'( 3978.0 >>> 00:20:21 SLIDE 12 of 22 adia& 5er3e At t%e E&bo/ ) ss f extens rs at t*e /rist and di$its( -ens ry l ss n t*e p steri r f rearm and *and( -i$n is ./rist dr p(0 -* ulder disl cati n may in:ure t*e radial ner!e( +ls . and t*e deficits / uld be t*e same as if t*e ner!e /ere dama$ed at t*e le!el f t*e elb /( .397855 >>> 00:19:51 SLIDE 11 of 22 adia& 5er3e At t%e A'i&&a ) ss f extens rs at t*e elb /.

and lumbricals 1 and 2= /ea<ened /rist flexi n= ulnar de!iati n up n flexi n f t*e /rist= l ss f pr nati n( -ens ry l ss n lateral palm and di$its 1. ?ea<ened /rist flexi n= radial de!iati n up n flexi n f t*e /rist= l ss f abducti n and adducti n f t*e di$its= l ss f *yp t*enar muscles and lumbricals 3 and &( ?ea<ened flexi n f di$its & and 5( -ens ry l ss n di$its 5 and ne *alf f &( -i$n is .cla/ *and(0 A'i&&ary 5er3e ) ss f abducti n f t*e arm t t*e * ri@ ntal plane( .cla/ *and(0 397880 >>> 00:25:01 SLIDE 1.At t%e 9rist -ens ry l ss n t*e p steri r *and "first d rsal /eb space'( 3978.cla/in$0 f di$its 2 and 3( -ens ry l ss n palmar surface f di$its 1. 2. t*enar muscles.ape r simian *and0 and . and ne *alf f &( -i$n is .:50 SLIDE 16 of 22 .flattenin$ f t*enar eminence(0 >arpal tunnel c mpressi n r /rist lacerati n( 397875 >>> 00:23:10 SLIDE 1+ of 22 U&nar ner3e At t%e E&bo/ *media& epicondy&e.5 >>> 00:21:0& SLIDE 13 of 22 2edian ner3e At t%e E&bo/ ) ss f flexi n f t*e di$its.of 22 U&nar ner3e At t%e 9rist ) ss f abducti n and adducti n f t*e di$its= l ss f t*e *yp t*enar muscles and lumbricals 3 and &( -ens ry l ss n di$its 5 and ne *alf f &( -i$n is . and 3.flattenin$ f t*e t*enar eminence(0 397870 >>> 00:21:&5 SLIDE 14 of 22 2edian ner3e At t%e 9rist ) ss f functi n f t*e t*enar muscles and lumbricals 1 and 2= . 2.ape r simian *and0 and . and 3. and ne%*alf f a &( -i$n is .*e axillary ner!e c uld be dama$ed /it* a fracture f t*e sur$ical nec< f t*e *umerus r disl cati n f t*e s* ulder( 397885 >>> 00:2.

*e axillary ner!e acc mpanies t*e p steri r *umeral circumflex artery as it passes ar und t*e sur$ical nec< f t*e *umerus( + fracture in t*is area c uld lacerate b t* t*e artery and ner!e( 397895 >>> 00:28:58 SLIDE 17 of 22 !&inica& !orre&ate 2id:S%aft "(mera& 4ract(re .397890 >>> 00:28:&5 SLIDE 10 of 22 !&inica& !orre&ate "(mera& 5ec) 4ract(re .*e radial ner!e acc mpanies t*e pr funda brac*ii artery( A t* c uld be dama$ed as a result f a mid%s*aft *umeral fracture( ?*at deficits / uld result fr m lacerati n f t*e radial ner!eB 397900 >>> 00:30:&3 SLIDE 28 of 22 .

397910 >>> 00:31:15 SLIDE 21 of 22 !&inica& !orre&ate .

/*ic* may dama$e t*e ulnar ner!e as it passes int t*e *and( .*e lunate is t*e m st c mm nly disl cated carpal b ne "it disl cates anteri rly int t*e carpal tunnel and may c mpress t*e median ner!e'( 397915 >>> 00:31:&1 SLIDE 22 of 22 !&inica& !orre&ate !arpa& 1(nne& Syndrome 8esults fr m c mpressi n f t*e median ner!e /it*in t*e tunnel( 4ract(re of t%e "oo) of t%e "(mate + fall n t*e utstretc*ed *and may fracture t*e * < f t*e *umate..*is fracture may separate t*e pr ximal *ead f t*e scap* id fr m its bl d supply "/*ic* enters t*e b ne at t*e distal *ead' and may result in a!ascular necr sis f t*e pr ximal *ead( .*e scap* id is t*e m st freCuently fractured f t*e carpal b nes( .