This is a teaching series to explore the basic anatomy which are relevant to the MRCS part A exams.
Basic Anatomy for MRCS Part A - Upper Limb Part 1
Summary
In this comprehensive teaching session, attendees will explore the anatomy of the upper limb. This will include a deep-dive look into the bones and muscles, and the braca plexus. Participants can expect to discuss the dermatum and blood supply of the upper limb and the anatomical spaces within it. The teacher will offer a unique approach to help remember critical features, focusing on key areas that are commonly tested in MRC Part A exams. From the scapula to the humerus, attendees can expect interactive discussions of common fractures and the potential risks of each. Whether you're studying for the MRC exam or simply looking to enhance your understanding of upper limb anatomy, this session has critical information to offer.
Description
Learning objectives
- By the end of this session, participants should be able to identify and understand the structure of the bones of the upper limb, including the humerus, scapula, and clavicle.
- Participants should be able to explain the importance of various sections of these bones, such as the greater and lesser tuberosities and the anatomical and surgical neck of the humerus.
- Attendees will learn about the various muscles of the upper limb and understand their function and connection to the bones.
- Participants should be able to recognize different fractures and dislocations that can occur in the upper limb and understand the implications these injuries can have on the muscles and anatomy of the arm.
- Attendees will gain knowledge on how to apply this anatomical knowledge to the MRCS part A exams, ensuring that they are able to answer related questions confidently and accurately.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.
With me. And today is just basically also looking at um the bones of the upper limb, the muscles of the upper limb. Um And then in subsequent classes, we look at the braca plexus. Um and all of the different aspect of plexus, looking at the dermatum of the upper limb as well as the blood supply. Uh But one of the things we also look at today is anatomical spaces that we have in the in the upper limb. Um If there are any questions or clarifications as we go along the way, um You can definitely drop a chart. Um And I will be more than happy to um respond to those questions as we go along the way. Like I said, the all lesson of um the conversation today essentially is to look at the bones, the muscles um and just to break things down a little bit. Um So that it's gonna be a lot easier for us to remember a couple of things that are important for um the MRC as part A obviously for persons who are not particularly planning to take the exams any time soon or for persons who are joining are not planning to take the exams at all. This is still very good or useful anatomy, um to know. Um, but like I said, um, it's gonna be um directed towards the MRC has exams and what is important or valuable for us to learn um for the exams now. So, starting with the bones of your upper limb. Um, essentially, um, I know, um, we need to start with the shoulder joint. Um, And that's where the scapula comes into play. And this is important because there are a couple of questions you're gonna find in mcs exams that are playing around the scapula. Um And the major part of the scapula um that will be played around are places like the infra um tubercle which we have here. Um As you can see from that middle image um as well as the supraglenoid tubercle. Um these two tubercles will be played around. And the reason is because you've got important muscles that attached to them. Um You've got the long head of the biceps um attaching to the supra tubercle. Um So think biceps, think supra, all right. Um biceps is like the um more prominent muscle when you um because one of the things I would try to do today is to give you some of the ins and some of the ideas that I personally used to help me remember a couple of these things. So for me to remember that the long of the um biceps attached to the Sagal tobacco. I just think about the idea that when you think about, you know, a super person or someone with a lot of muscles, what is very obvious is the biceps? All right, you talk about the biceps muscle and, and so you think, think about biceps, think about supra, think about superhuman, think about a puffy man. So that just helps you remember that. And the good thing is once you remember, so one of the things you would discover as we go along um with our conversation today is that all you need to do is, you know, one thing. So when you have two opposite things, right? So once you know, one thing, you can always think about the other one as the opposite of it. So if you know that the um long of the biceps attaches to the sagar tubercle, it just invariably you can remember that the infra in the infra tubercle. Um That's where the long of the triceps inserts. Alright. So that, that, that becomes a um a very easy one. All right. Now, obviously, we know that the fossa it is, is this is what creates, that's that as that depression, a cop like depression that you've got in um the lateral aspect of the scapular where the head of the humerus will find its place to insert. Obviously, when we can talk about the humerus, we'll see a couple of things. One of the things I've tried not to do in this presentation is to notice a lot of um information, just want us to have a, just want us to have a discussion. And I think that that's gonna make it a lot easier for us to go through if um the things we discuss are simple things that will help us to remember the simple things um as we go along. All right. So the other thing to remember or the other part of the scapula to remember is that when you look at the posterior aspect of the scapula, um looking at this um other image on the, the the to image on the screen. Um You would see that um the the, the scapula has got a spine um which divides it into the supra um Spinatus fossa as well as the infraspinatus fossa. So that spine that runs across the back of the scapula goes all the way to form the acromion process. All right. And then you've got this other process which comes just um medial to the um Glena fossa forming the coracoid process. Obviously, these things are important. The quad is important for us to talk about when we begin to talk about um some other muscles that attach to the process. But like I said, for the conversation today, it's just us essentially taking a look at simple things that are important. Now, um the infraspinal fossa obviously will house at some point when we begin to talk um when we begin to look at some of the mus muscular attachment um would house the infraspinal muscle where the supra fossa will also house another muscle called the supraspinal muscle. So essentially, that's, that's where those muscles are going to be arising from. And you'll find the incisions areas around the um sorry areas around the humerus. And then we'll begin to talk about some of the um attachment to the humerus, the things that attach to the g humerus, the LC, the humerus. And we get to talk about all of that as we go along. Now, just not to waste our time. Let's look at the clavicle. Um The clavicle is this other like um bone uh which also um we'll talk about a little bit. Um But it, it, it has the acromion and that's gonna attach to a acromial process, which is that spinal extension of the um spine of the scapular. All right. Um And then you have the acro and, and then that continues to the standard end. One of the things I would try to do in the conversation um Today is once we run through all of these bones, I would um just show you some through the anatomy just to help again. Um help us remember these things a little bit better. Now, talking about the humerus itself. Um the humerus itself is, is another um All right, I is another bone that's quite very important and you'll find a lot of questions that are gonna come up relating to the humerus. One of the common questions you would find. But before we talk about that is, I think it's better for us to talk about some of the different aspects of the humerus. Um, we've got the head of the humerus. We've got the anatomic neck of the humerus. We've got the surgical neck of the humerus and then we've got the greater tuberosity as well as the lesser tuberosity. Now, it's important why these things are important to us is that one of the questions you will find sometimes is they could ask you which each of this muscle attaches to the greater tuberosity or sometimes which of these muscle attaches to the lesser tuberosity. All right. Um One of the muscles we will talk about as we go along is cuff muscle and most of reserved cuff muscles attach to the greater tuberosity, right? Um Just one of them doesn't attach and that is a Solaris and we'll talk about that as we go along. But that is important for us to talk about. Um some of these things um in terms of talking about the anatomical neck, the surgical neck. Um and, and the, the what makes these things important for us when you look at questions? Now, one of the things that makes this important for the anatomical neck is that once there is a fracture along the anatomical neck and then we'll begin to talk about the fact that there could be a avascular necrosis of the head or right of the humerus. Whereas when we look at surgical neck fractures, we're looking at structures that spin around or structures around the surgical neck of the humerus. Um And one of those structures that we will talk about is the axillary nerve, right. The axillary nerve finds its way to spin around the neck of the humerus. Um And if you can remember this axillary nerve plays a role in supplying a couple of muscles um that are important for the abduction of the forehand. But we will get to that and we'll talk more about that. Now, when we look at the distal part of the humerus, and we'll look at the lateral epicondyle as well as the middle epicondyle. The media epicondyle is particularly important because that's around where we refer to as a funny bone where we've got on the posterior side of it. You've got the ulnar nerve lying there and it is a part of the things we'll talk about as we go along. Um Certainly in the next uh um next discussion where we will look at the nerve supply of the upper limb. Now we talk about the choc uh which you can see here. Uh It is painted green and the picture here and then the Ocran fossa which is painted yellow here. Um All of these um are structures the process itself is a structure um that we also talk about, um which is a part of the process that you find on the um um on, on the bone, which we'll also talk about as we go along. All right. So now, back to the, and here we can see the can itself being painted as green. Um We, we have the coracoid process being painted as red and we've got the radial notch, which is where the radial will gently sit. Um That obviously, these things are important when we can talk about some of um some of the fractures that occur and some of the dislocations that we get with um fractures of the forehand, which we would also take a look at as we um go along at some point, but n not to waste our time at all. Um I think that so far um one of the things I've tried to mention when we talk about the humerus talk about bug that you need to know um in terms of surgical neck, anatomical neck, the difference between the two. All right, the, the, the anatomical neck is the the actual part um which that's the part that is painted yellow in this particular image um at, at against the surgical neck and the differences of what we are worried about when each of these things occur. And these are some of the questions that tend to, they, they tend to play around in the actual exam. I think I've got a couple of questions at the end that we can also look at um that illustrate some of the sample questions and some of the past questions of from the MRC S that addresses some of the um things around the bones and the muscles of the upper limb. Now talking about the radial um which is, well, we're looking at the radial head, um we have radial head, we've got radial neck, I've got the radial tuberosity. Radial sis is important to us because the biceps, you know, finds its way to attach to the radial tuberosity which we will talk about um shortly. Um again, looking at some of the structures here in terms of the um bones of the hand, we can see how the radial tends to articulate um at its distal part. Um So we've got the radial um very closely leaning to the scaphoid lunate as well as the trach. We'll talk about all of this um quite very shortly. Now, this is just a key point. This is a very, this is, I think this is one of the questions I saw in my MRC S but a a very common question to see. But it is a question we talked about the lunar dislocation can lead to injury to the median nerve. But again, this I just keep point was to talk about a lot of these things. Um when we begin to talk about the nerves and what nerves get damaged when we have different dislocations or different injuries. Now, let's talk about the copper bones. Now, one of the, one of the easiest way to remember the copper bones is one of the ways I've tried to remember is, is to say she looks too pretty, try to cut her. Now, you might have your own ways of coding it, but it's quite, very important. Um It is a very common question. You would find um questions around the copper bones. Um She questions around the Sipho bone um and questions around the capitate. Um These two bones get talked about quite a lot. Um um and then very rarely the lunate, um which, which I've talked about the fact that of the unit will lead to an injury or um damage to the median nerve. But it is quite important to know the, the, the, the, the, the Kappa bones. Um It is quite very, very important. Uh All right for us to know about the Kappa bones. Now, like I said, the, the there, there might be different ways or um that as individuals, we have found a way to code or to um you know, put these things have ways to remember these things. But like I said, it's quite, very important um to remember a very simple way, like I said, is she, she's starting for the scaphoid. Um looks. Um that is and that's the lunate try. That is um TRM and then the pisciform, which is very gently on the trach. And then you've got the trapezium. Um You got the trapezoid decapitate as well as um the hamate. Um Obviously to talk about some point about the hook of the arms and things are important. Usually, when we go along, we'll talk about the scid. Um And what's about the scho um as well as I think one common questions I've seen around is them asking about the capitate. And then there is this question that tends to fly around about what, which of these bones does not attach to the capitate. And you would realize that almost. So you've got, you've got most of the bones attaching to the capitate. You've got the trapezoid a having an articulation to the capitate. You've got the, um, scaphoid attaching to the capitate. You've got the lunate, you've got the hamate. Um So essentially, you've got no about four bones um that I got some articular surfaces um to which they join the, um, the, the capitate. Uh All right. And, and those kind of questions, does it occur where they act, which are the following bones does not um, attach with the capitate? All right. So talking about the, like I said, a lot of things we're looking at are quite, very soft, uh not too, very deep anatomy because now we're not here talking about the muscles or the nerve supply, but a very common common questions that, that we also find, which I think a lot of us will know is relating to when you have fractures of the distal radius um where we can have the col fracture as well as the fracture. Obviously, as individuals, we can try to code this whatever way it is gonna be easier for us to remember. Um what I always try to remember. All right is remembering where does the displacement occur. So for the slits fracture, all right, that will be um whenever we're looking at displacements, when it comes to orthopedics, we're looking at um the position of the distal part, all right, to the rest of the body. All right. So what happens in fracture is that the fracture? All right, distally is displaced on the to the volar side? All right. So you can have that as you know, call that as Smith for Volar um vs or SV, whatever is going to work for you. Um But what I've always used to code mine is to remember the colli fracture. And whenever I remember that the cli fracture there is a displacement to the dorsal side. All right. Um That helps me to remember because I just call it as CD or DC, Washington DC. So I just remember it as DC um or direct current or whatever um works ee essentially. Um So I II think that you could call it whatever way you think works for you. And by doing that I think it makes it a lot easier um, for you to remember, like I said, if you can remember one of it, then it's gonna be a lot easier to remember. Um, the remaining ones, um, which is essentially the way I have tried to code um, these things. Now, the, the, the other thing we will talk about, like, like I said earlier is a scaphoid fracture. And what makes the scaphoid fracture unique? All right. Um One of the things we would, we would find a lot with um a lot of um the questions um that we will find um um one of the other things we'll find some of the questions uh along the lines of um the scaphoid fracture is or along the scaphoid is questions along how do you manage scid fracture? I think we would look at that subsequently, but just to put an insight to that and, and if you do find questions like that is to always remember that the scyphoid has what looks like um a, a, a, a blood supply that that is in reverse. And, and what, what I mean by that is that the blood supply basically comes from distal and then that progresses um um proximal. So it starts from distal and then progresses proximal. In other words, when you've got a fracture of the um uh o of the scaphoid bone, all right. Um And if that fracture is a lot more towards the neck of the, of the scaphoid or if it's towards the body of the scaphoid, we realize that the distal part of the um scaphoid tends to survive because that's where the blood supply actually starts from. Um But the proximal part of it tends to die. All right. Um And it's quite important to remember this because this is one of the questions that would, that you, um that you will find a lot in the MRC S. But I think what they tend to test is when you've got someone that's got a um that, that you've got someone that's got um tenderness in anatomic as not box. And usually whenever that's the scenario being painted, they, they are painting scenarios around, around the sca bone. And when this usually is the case, what tends to happen is that they are act actually a um if um in terms of when do you start management or how do you go about management? So what tends to happen if for most persons is what is 10 and tenderness in the class, not box, but extra has not shown any fracture at all. All right, then obviously, what's on person we'll do in recent time is to do a CT and CT will help you make a decision straight up. But w what tends to happen, at least for now, for most of the Mr expressions is that they're expecting you to say you will re x-ray in about two weeks and then if there's still nothing, then you can afford to remove whatever splints you've decided to put on the patient. Um, but if usually after two weeks or between 1010 days to 14 days, you should be clear if there is a fracture or not. And if there is a fracture, then he needs to fix in. Um, and usually the, the ideology is that depending on the part of where the fracture is that will determine what type of fixation um will be required for the patient. Again. Um Montana fracture and Galia fracture is in that question that tends to play around and that still has to do with fractures that you'll find in the upper limb bones. Very simple things, nothing too deep. This is not orthopedic, this is basic anatomy and so um you will not be tested on um the others of thing. OK. Um um All right. So um sorry, just a moment. All right. So um for the Montane Gel, um I think one of the easiest way to remember it is to remember it as it is a fracture of is it um of the er with um a dislocation of the um with, with dislocation of the proximal um radial ulnar joint, right? So it is a fracture of. So one of the easiest, like I said, one of easiest to remember is to remember Montaner I remember is an fracture. And so one of the reasons I try to remember that if a football fan is Manchester United, mind you. And if I remember, man, you, I remember M for Montana and U for honor. And that helps me to remember that it is an honor fracture. And then AAA um a radio joint, um a proximal radioulnar joint dislocation. Whereas for the G A fracture, it is um Y here you're having a um radial fracture. All right. So again, like I said, I don't particularly have a code for G for the Gallii fracture. But I remember if I can remember the Monte, I know that the opposite of it is the giai. And if it is the opposite, it means here you've got the radial fracture and you have a distal radial ulnar um joint dislocation, right? So one of the ways to remember things that are almost like that, that almost of each of that is remember one or code one and once you code that one, it will be a lot easier for you to remember. Um the remaining ones. All right. Um So just to take, to begin to talk about quickly about the muscles. Um So for um the muscles of the upper limb, we've got the little cuff muscles um which are quite important. Um And I think I tried to mention them earlier when I talked about the subcapillaris, this, which is the one I said that attaches to the LT uh which is, I mean, that's why I talk about the GT as well as the LT, uh, which is a, um, talking about the greater tub as well as the lesser T um, it is quite important to, to remember these things because there's also a simple questions that tends to be a, um, for upper limb anatomy where they actually you have muscles attached to the GT and ones who want attached to the LT. And like I said, um, one way to always remember the cough muscles is a seat. Si Ts, all right, si ts sits. Um they are the muscles and it's quite, very easy to remember them. All right. Um The subsequent lar the super as the infra suppressor and the terrace minor, essentially, they are also supplied by different um nerves. Um the subs sorry, the supra, as well as the infraspinatus are supplied by the same nerve um y the teres minor um which is also supplied by the axillary nerve, which would get you when we begin to talk about um the now supply of the um upper, now. All right, some of the other muscles we talked about the attachment um of the long head of the biceps going to attach to the supra. All right, supra and tac. Um while the, as you can see from the pictures here, while the short attaches to the coracoid process, obviously, some of the other muscles we've got in that part of the hand, um we can always remember that code, which is the BBC, which is the biceps brachial, the brachialis, as well as the coracobrachialis. All right. And on the posterior part of it, um we've got the triceps which has got the long which attaches to the infra um you know, tubercle as well as the lateral and the middle. All right. So, um that's the on the back of the hand. Um And we've got the anchors muscle also, which we've got also on the posterior part of the hand in terms of the foreham. Um if we feel those muscle to remember, um And that's because they play a very critical role in terms of some of the movements that we will get tested on in the MRC S part A. And when we talk about the upper limb anatomy, um I think the ones that very, very important for us to talk about is that the two big muscles, both the flexorium Profundus, as well as the flexor um digitorum superficialis, right? These two muscles are important for us to talk about because they will play a role or we will get tested um on this muscle. Obviously, when we begin to talk about the kn supply, we will also begin to talk about some of the other muscles and the roles they play. But in the meantime, I think that is worth of note to just talk about the role of the flexor deterrent profundus, which is one of the, which is the muscle that is responsible for the flexion um particularly at the D I PJ. Um while the superficialis which is a similar muscle will help with the flexion at the. Um P I PJ. Obviously, that is a proximal interphalangeal joint as well as the distal interphalangeal joint. So, remember the digita um that should code in your head as distal digita, distal, all right. Um And so it controls, it helps with the flexion at DDI PJ, which is distal interphalangeal joint. Um while the other one which is superficialis superficialis, um obviously, I know that both of them have digita. But the way to remember for me is remember remembering that flexor digiti profundus um is it, is, it is, it will help with the flexion at the D I PJ while the flexor um digita superficialis, that's superficial, that's more proximal and that's going to help with flexion at the P I PJ. All right. Now, we'll talk about some of the, some of these other muscles in details when we begin to look at N supply. But in the meantime, um we're um w we're basically just looking at these muscles just so that we can um have an idea of what they are when we can talk about our functions a little bit later. All right. So we've got the um other ones, Flexor Carpi rais the um the Primaris Longo, which we also talk about and some of the roles it plays. Um we'll talk about the flexo car or, um, and we'll talk about, um, the parental terrace. Uh, we will talk about, um, some of the other muscles like the parental quadrati. Um, which is a funny muscle that we get easily tested on when we begin to look at the anterior inter um, nerve, which is a branch of the median nerve and some of the structures that it supplies, um, and the parental cord arteries, you know, is one of such. All right. Um um All right. So WW we'll, we'll do, I have to do a couple of these things um, as we go along the way. But again, um, still looking at the muscles of the forearm, I've got some of the other muscles on the posterior part of the forearm. Um The should be the abductal policy is longo um, the extensor policy is longo as well as the brevis, the extensor indices. Um, the, the brachial radialis extensor cus, radialis long and breakfast, um, the extensor mini um ex copy or as well as the anchors, which I talked about earlier now. So, essentially not to bore yourself. You realize that all of these muscles are not particularly all tested in the exams. Um, most of the past questions and, um, and some of the recalls I have gone through while when I prepared for my exams, I realized that it's not particularly important to understand a lot of these muscles or to know their incisions and things like that. But a couple of them that are quite important for us to know, especially when he talks about when we're looking at the function of those muscles now, which we will still get to. Um So enough, I think it's a good thing to understand the external compartment of the for forehand. Um I think it's a good knowledge to have. Um However, I do not think that it is very important to sort of try and cramble them or try and remember them. I think what is important to remember is probably the um third compartment which is called the E PL. Um I think it's, it is good to remember that E PL is in third compartment. But to be honest, I do not think that and I have not seen that being overly been tested for the MRC S. Um you having a full understanding or remembering all of the different muscles in different compartments. But if it's something you think you will be able to remember, I think it is a good knowledge to have. Um There are six compartments. It's good to know that and to know what structures are within the various compartments. If you can remember, that's good. But I did, I've not, I didn't come across as being overly tested for the MRC, but it's good to remember um these things. Um definitely, II think it's quite very good, obviously, um one of the ways to remember it is to remember the fact that the the the muscles are, if you check here, the first compartment contains the pollices. The next one contains the radialis. The next one contains which is the odd one out which is the policies longo. All right. So the first compartment containing the um policies, the second compartment containing the radialis, the next compartment containing which is the top compartment containing this strong different muscle, which is the extensor policies longer, which is the E PL. But if if you go along that way, you will be able to, you will be able to remember and you remember that the fourth compartments not deals with the the big one, the biggest one which is that um tendon that is gonna find out to the the four fingers, which is the extensor digita as well as the extensor indices. All right. And then which is indices of which we're talking about the index finger. All right. And then we talk about the digital mime which is now not going to be on the most medial side as well as the extensor CN, which is going to be on the on side. So you, you would realize that if you think about it that way that uh you know, you will be able to remember starting all the way from the um radial side, which is where we got the first compartment where we begin to look at an nerve box. We we realize that those two muscles that form the first compartment um essentially would form where we begin to look at the at a box will form the lateral side or right in the lateral side of the atomic no box. And while the extensive policies long goes, which form the third compartment would represent um the um lateral border of the atomic as box. But again, like I said, it's an easy way to remember if you want to remember it, if you want to cram it, which is remembering that we're starting from the pollicis, which is from the rider, um which is from the, the um radial side, right? So starting with the Pollicis, which is a big to which is a tom there, you're looking at the extensor of the, of the tom as well as the abductor of the, of the tom. And then you, you go on to enter into the um the essential cis, the long and the Brevis and then you get to the top compartment which is where your um E PL is. And then following your E PL, if you go to your, you go to your digita that spans to the four fingers as well as the, the extensor indices. It goes to the index finger and then you move on to your digital mini me and then from your digital mini me, you go to your car AIS and that's, that's an easy way to remember if you want to if you want to remember this, um not to not to waste our time. Um I think one of the things I just want to talk about, um I think your que question you will find, sometimes it would ask you is if a patient is unable to lift your thumb from the the table, what um structure is most likely damaged or what nerve is most likely damaged and uh taking your lifting your thumb off the table. I you can see on this in this picture is a function of the E PL. And sometimes it will tell you what, what muscle has been tested for the in the, in the retro portion test. All right. And that is the E PL. All right. Um Obviously, when we can talk about the nerve supply, we would also get to talk about some of some of these other um aspect of it. All right. Um Again, one of the things to talk about is again, the um various movement of the thumb. Uh I think I'm quite confusing for a lot of people. Um when we're trying to remember the various for um types of movement, you know that you get with the thumb, right? We've got the abduction of the thumb, right? This is essentially when you move your thumb to about 90 degrees as if your, if your thumb is pointing to the sky. All right. If, if your palm is. So if you, if you have your palm faced upward and you point your thumb to the sky. That is the abduction movement. All right. That's, that's when the thumb is abducted. And the abduction of the thumb is when you bring it to the side to, to align with the other fingers. All right. And extension is when you move it on that same plane of the other fingers. When you bring it out, that is the extension and the flexion of it is just when you bend it in. Um why opponents is when you try to touch the M CPJ of the fifth finger or of the little finger, when you try to move the tongue to touch the um mm CPJ, which is the, so when you try to start the M CPJ, right, that is when you are doing opponents that's not showing in these pictures. But I think it's a good information to have. Um because I think it's one of the things that can be quite, very confusing. Um Again, when you look at um these things, um when we look at a simple anatomy, all right, um muscles of the hand, all right is quite, I think one of the just so I can begin to look quickly. Um because I think time has really gone is remembering the muscles in the TNA M and as well as the muscles in the hypo TNA M and one of the easiest ways to remember these muscles. All right, is that obviously an easy information for you. We, we get that when we get enough supply is that the muscles of the 10 min are supplied by the median nerve, right? That's on the lateral side. And the ones on the uh Ti and NS are supply, sorry, the, the ones, all the T and N are supplied by the media and the ones where the apple are supplied by the um on and off. But we'll get to that and we'll talk about those things much later. We begin to talk about some of the paradox of the media, nerve injury as well as some of similar kind of pads that you can also get with the nerve injury. But talking about remembering the muscles of the TA N. All right, always remember the, the code I've tried to use for it is ofa ofa um organization for, for food, whatever you, you, you can, you can always try and pin down quotes for yourself for me, Ofa. I just always remember Ofa Ofa. And what does that stand for? Oh, for the opponents? All right. So you've got the opponents polys, right? And then you've got, you got an F which is a flexor and you've got the flexor policies, Brevis. All right. Don't forget that all of these are all at the base of the thumb. So they are all gonna be policies, policies, policies, policies is the thumb. All right. So you've got the o which is the opponents policies. You've got the f which is the, and don't forget that they are, they are all short muscles, they short muscles. So they are brevis, short muscles. They are brevis. Remember that short muscles? Brevis, the idea of brevis is brief and that means short. All right. So, remember, remember that when you think about the um muscles in the TNA eminens? All right. So the first one, the o the opponents um which, which helps you to do a position which is like I said, touching the base of the M CPJ of the laser finger, right? So the o the opponents, the next one is the, the F which is the flexor and that's the flexor um policies Brevis, the F PB, right? And then we've got the last one which is the abductor, the abductor, the abductor policies, Brevis, right? So you've got two Brevis. So you've got the o you've got the F and you've got the um A, the o represents your opponents, the um F represents your flexor and don't forget that it's a flexor that is shot, which is Brevis and it is a flexor of the thumb. So it's po policies, right? And then you got an abductor which is also a shot, abductor and it's also an abductor of the thumb. So it is a Brevis and it is a policies, right? So it's abductor policies, Brevis as well as the Flexor policies, Brevis. The same thing applies to the T put on M and M. All right, here we are dealing with the digit mini me which you're talking about digit mini me talking about the mini, the small digits. All right, the smallest digits, which is the fifth digit, right little finger, right? So again, it is also ofa so remember opponent digits mini me, remember Flexor digiti mini me, Brevis, I remember the abductal DT mini me. All right. So it is important to remember these things. All right, because again, you will find yourself being tested along the lines of these things. You can actually which of these muscles is a component of the T in. And you don't want to always forget this. This is something that you can easily remember and you can stumble on them on some of the MC Qs um for the MRC S exams. Now, one of the things I found very easy went to MRC exams is how the standing, you know, you could do a lot of the recalls and a lot of the past questions and some of the question banks. But having an understanding of some of these things make things a lot easier. So that when little bit of questions are changed, you can still remember things right. Now, one of the questions we will find, for example, is now talking about the intrinsic muscles of the hand. All right, we now have the lumbricals and we have the interes we have 44 lumbricals and we have um we have four laundry girls and we have um seven octial muscles and, and, and always remember that there are four palmar, sorry, there are four Doz um inter rot and there are three palmar, inter rot. Obviously, some of the questions that you will find being asked um is what, what exactly is the rule or what, what is the function of the L house, for example, right? The lumbrical is one of the roles they play that they play a role in the M CPJ flexion, right? They play a role in the MPM M CPJ um flexion and would, would get all of that when we begin to look at nerve supply. Um and one nerve supply them and things like that, we'll talk about the la lateral Truls being supplied by a different muscle and the middle uh lumbrical has been supplied by a diff sorry, the lateral to lumbrical supply by a different nerve and the, and the medial um lumbar cause being supplied by another nerve. All right. So in terms of the inter, there are seven of them, three of them are do three of them are the back and you call the palmar ones and they are so four of them are docile, three of them are palmar, four, docile, three palmar. Now, I think one of the ways I try to remember the, the palm out is to remember that it is 34 So it is 3434. So um I just remember trying to remember that three is on top of four, right? So, um and what I mean by that is that 34 can carry three. So II think about that when I think of my hand, I look at my palm and I'm like, ok, so I've got on, on my palm, I've got three and on the back of my hands, I've got four. So it is 34. Again, whatever works for you, whatever helps you to carry that connection of memory just so that you're able to remember these things and you don't find yourself struggling. Now, these are simple things that you might know. But in an exam situation, you can find yourself now slightly confused which, which, which one is three, which one is four. And that's a very simple question that you shouldn't be missing. All right. So um the in the in interracial muscles, again, we later talk about some of their functions, which key function is that they play a role for the dorsal, you can remember the word dap, da B dap. And that's because the dorsal interracial will play a role in the abduction A B duction, right? Why the PMA ones is pad P ad pad pad. So they play a role in the a deduction. All right. Um of the fingers quite very important. And one of the questions that you can find being asked. All right. And you should be perforated. Is that the palmar ocal muscle does not attach to the middle finger. It doesn't attach to the middle finger, right. So the middle finger has no, has no pal. All right. Interros attached to it at all. All right. That's something worth remembering. And that's a simple one that you also want to miss in an exam situation because I think it's a simple one that you could get a and I think it's a good one to remember. All right. Now, essentially, I think the only one we're gonna talk about is the adopt policies, um, which is another important muscle, um, which is the only muscle that you'll find close to the thumb that is supplied by the ulnar nerve. All right. Um We'll get to that later or we can talk about, um, the supplies. The other thing I want us to look at today is, and I'm just gonna bridge through that, um, as quickly as possible. Remember the chr the chondroblasts because you're gonna find a couple of questions talking about. It's really about the content of the chondral space, which um you should remember is a branch of the axillary nerve. Uh what can be found there, um, as well as a posterior sarcoma artery. All right. It is important to remember this because a couple of questions are gonna play around this. All right. And also try to remember the boundaries of the chondral lo space. What are the boundaries? Trying to remember? Remember that it's called a terrace minor on top and it's called the terrace major below. All right. Think minor are major below. Think major carrying minor. All right. So if you think about it that way, say I talk about the, the inter muscles that you got 34, you got three on top, which is on your palm and you got four behind four is carrying 34 is and three. So you can carry three the same way. Think minor and then major, right? Don't confuse you to think it is major, then minor because you can find questions to say, oh, and what structure forms? So, so and so border of the glass space and you don't wanna miss that. All right. So you've got the um minor forming the superior border of it. You've got the major form in the inferior border of it. And then you've got the long a all the triceps which is the same long, it's going all the way it's gonna attach to the infra tubercle of the scapula, right? You've got the forming as it were the medial um um border of it. And then you've got a surgical neck of the humerus forming the lateral border, right? So medial body being formed by the longer of the triceps and you've got the um surgical neck forming the lateral. Um But now, one of the things that's important is that the content. And here I talked about the content and the content here is the axillary nerve. Don't forget that we say the axillary nerve spins around the neck, it like of the, of the humerus. And that's where it comes out from spin around the neck of the humerus. And that's why we have the surgical neck of the humerus forming the lateral bladder right there. All right. Now, the other thru that is there is the the posteriors complex humeral artery because sometimes the in the options, they would deliberately not put axillary nerve because a lot of people know the axillary nerve as a content of the chondroglossal. She also know that the posterior are complex humeral artery. So the content and sometimes that's all that you'll find in the option. It's a complex humeral um artery, right? Remember that also is a component of or end that structure that passes through the chondral glass space. Now, another space we have just below the chondral glass space. E tri space. All right. E the tri space. All right. Um And it, it is, it is important to remember um the the tri glass space. Um And, and this is just because of the fact that um it is, it is a tiny space. Um but it, it has also also got, again, its superior border has been formed by the in terrace minor and the inferior body is referred by a terrorist major. And then you've got the lateral. Um but uh being formed by the long head of the triceps, the same lateral. But that, that is the same longer of triceps that forms the middle. But for the chondral glass space and the content here is a circumflex scapular artery and vein. So you'll get this, you get a sex scapular artery and vein. Just remember that. All right, again, talking, talking about the axilla, axilla is another thing for us to remember another area for us to remember, especially when it comes to the the content as much as we need to remember the borders, right. So the borders on the anterior aspect is formed by the pectoralis major. Um The lateral is formed by the intertubercular circles of the humerus. Um And then we've got the um the posterior border being formed by this the terrace major latissimus dose as well as the subcapillaris. And then on the other side, we've got um it it all other border also being formed by which is the media border by the crotos anterior cto anterior is an important muscles talk about or we can talk about the BRAC flexus and some of the supplies of the brachy flexus. And when does stores that damage, what we expect to find running to the citalo because of our time. Also important to remember some of the content of I want to use that course, saying you really need be a to be at my nicest, right? Talking about the content, which is the radial nerve, um the biceps tendon, uh the brachial artery as well as the media nerve. One of the things we'll find in the exam is the question of they tend to act around um the arrangement of structures within some of this compartment. And one of those compartment is the fossa. In other words, what is most medial? Um what is most lateral? What is, you know that that question tends to play out and we'll look at that um subsequently when we begin to look at the nerve supply as well as the blood supply of the upper limb. All right. So these are the boundaries, the brachialis, um radialis forming the lateral border. Um And then we've got the um you, you got the prenatal te you know, essentially um forming the medial border of the coital fossa, right. Um This is the carpal tunnel. It's quite also important to us talk about the carpal tunnel. Um because we also look at a few things when we're dealing with the carpal tunnel. Um But I think the most important thing to remember um when we think about the copper carpal tunnel and its content, which essentially is, is the median nerve. But also remember that the median nerve gives off a palmar branch just before it goes into the kal tunnel. All right. Um Obviously, the roof of it is formed by the flexor retinaculum. And you've got the contents which are the flexor policies. Longo the Flexorium Profundo and the flexorium Super. So all of the flexors essentially go through that. And then you've got the, the median nerve also in the lung. And then that's why when you've got a compression of the carpal and sonal, you're going to see some of the effect of the median nerve. I would get to look at this. When we look at the median nerve, I realize that um what type, what are the loss of functions that we expect when there is ca carpal Tonel or when when there's an injury to the median nerve at the level of the carpal tunnel. And there's some of the things that we will definitely look at. Now again, we'll talk about the extensor compartment earlier and I've tried to give um a way we can remember external compartment and not talk about the anatomical SNB box which we've tried to talk about. Now, remember the SNB box quite very easily if you put your hand, if you stretch out your hand. All right, you can see the E PL and that and the E PL represent the, the medial border of the anatomical box. So the medial border of gonna have to form by the E PL, which is the extensor is loos, which is what is painted blue here, right? That's the more prominent tendon you can see when you stretch out your thumb right now on the middle, on the middle side, sorry, on the, on the main side of it formed by the E PL but the lateral border of it is being formed by two muscles which is the extensor policies very as well as the abductal policies. Longo which are the structures we said we are going to find in the first compartment. First is the extensor compartment. All right, the extensive policies as well as the abductor policies. LS. All right now, um just before we quickly round off, um I'll just run through a few questions randomly just for us to be able to see them. Um OK. I've seen a lot of people talking about the fact that these lights are not moving. I hope these lights are moving now. Um I really hope that these lights are moving now. Um They didn't get to see these messages earlier on time. Um I hope these lights are moving now. II really just hope that you guys um uh seeing this light now and I think there are some glitches of the ne of the network. Um All right. So um just look at a few questions that are related to, for example, the um MRC SA couple of the recalls and a couple of the question banks where this one talk about which muscle is responsible for constant in flection of the digital of the distal interphalangeal joint of the ring finger. All right, of the ring finger. This is just a, a trap. All of the fingers, all of the four fingers with the exception of the thumb. All right, have the D I PJ, which is this stuff. Endal joint being flexed by the flexor digi profundus. Then we talk about this earlier. All right, this is some of the questions are painted around and you could get confused. All right, we're gonna say which of the fing, which of the muscle does not attach to the radio. Again, it tells us that it's quite very important to understand what muscles attach to what bone. All right, we know that the biceps attaches to the radial tubac on the radius. We know that the prints is one of the muscles you find on the, on the distal end of the um hum sorry, the foreham and it does attach to ras we know about the brachy radialis, which is, which is another muscle that definitely attaches because again, brachial, it comes all the way across the, the um it comes across the brachial um sorry, the, the uh cubital force and the fiance is way all the way down and it does attaches to the radios and his name already carries radialis. And we have the which also does attaches to the radios in the proximal part of the radius. Why they break out is, is the muscle that does not attach. Now, it is the point of going through these questions for us to be able to see some of the type of questions we would find that are related all right to the muscles as well as the bones of the upper limb when it comes to the MRC S because these are sample past questions of the MRC S questions. All right. Um So what muscle is more of a flexion of uh of the I PJ of the tongue? There is a question, this is something to remind yourself of which are the following is not intrinsic muscle of the hand. So they're asking about which muscle is just within the hand itself. And we will be able to know that is the primary long. It is not an intrinsic muscle of the hand. We talk about intrinsic muscle of the hands, which are the muscles of the IPO, the apo um muscles, the thinner muscles as well as the lumbrical and the interracial muscles. This, this, these are essentially are the intrinsic muscles of the hand. All right, you'll find which is not a carpal bone. Obviously, if you can remember, we have, we've talked about the code for it. She looks to pretty try to cut her. All right. So which of them is not? And that is the um trapez, all right. Trapezius is, we've got Trapez muscle, but we've not going Trapezia bone. All right, it is trapezium and Trapezoid. Those are the right ones. Trapezium and Trapezoid. All right. Um Again, these are simple things just so that you see that they are very simple things in the upper limb that if you're not careful about, you can mix things up and you can miss out on very simple, simple questions. All right, you got this question talking about the carpal tunnel um is really explored surgically. One of the four instructors will lie in close proximity to the hamate within the Kappa Tonel. Right. Again, simple questions. But we need to, we need to read around these things because they're quite very important in the exams. All right. Um The axons which treat those following structures, does the axillary nerve pass? We've read this, we know that that that's the quadrana space, all right. Um which are following fingers is not, is not a point of attachment for the palma Interros. We talked about this and that is what the middle finger, right. So, just to look at some of the simple things that you find being played around in the exam. The following is not closely related to the carpet bone. We try to look around which muscles don't even come close to the carpet. All right. Um And it's quite very important. This is a very funny question that can be asked around the carpet. All right. Um This is also talked about a patient who has got a small cuff of tendon still attached to the radial tuberosity. Um and is consistent with a recent tear. All right, one muscle attaches to radial tuberosity. And we know that is the biceps breakout. That is the radial tuberosity on the radial nerve on the proximal side of the radial, sorry. Um I thought the radial uh the radius, all right, the radius um on the proximate end of the radius. All right. So you'll find a lot of these questions. Uh you know the axons again, um which of the following is most limited to the axillary nerve within the cord gland space and a posterior, a complex ier vessel. And, and you'll find all of these questions. Um No time. How many dosa Interros are, are they are there? All right. Remember I say 34 and that should be four. All right. Um They're asking again about structures articulated to the of superiorly um asking about which muscle is not the cough. I'm talking about this as the six muscle s its you know, so essentially, um these are some more simple questions that you will find that related to um the um MRC S. Now, what, what we'll try to do today essentially is to just look at the simple things. I know a lot of these things. A lot of you guys already know these things. Um They are simple things, but there are things that are quite relevant. Alright. Um to the exam. All right. So essentially, um we, we will be having a patch too, which is where we look at the blood supply as well as the nerve supply. I think the B key all, all the, the most questions we're gonna find in the MRC S are gonna be majorly around the um are are majorly going to be around the um the nerve supply. So you're gonna be a lot of questions around my nerve supply in the M CS. All right, lots of questions around the um lots of questions around the um um NAF supply and we're gonna be looking at that in detail and we're also gonna be having um somebody else also be with us next time and um the next one should be this coming Friday. Um So we'll also send out the invitation and settle of the meeting. Hopefully, we, we, we'll have things better organized um for them. Um A big thank you to everyone who has joined in. I will just want to encourage us to please complete a feedback form um after this. Um And I'm, I will do well to send the materials to the people who have asked for it. Um I will do send it to you, right? Um I think we've come, come to an end of the discussion today. I hope um this was useful for those of us that are preparing for the exams. Um And wishing you guys all the very best. See you guys next week for the ones who will be able to join us next week. Um Just to begin to look at the na supply of the upper li All right, you take care.