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All right, thank you very much. Um I think we can um get started now. Um I think it, I think we've got quite um just so that we can maximize the time that we have. Um I think we can get started. You got about um 12 people, uh probably about 10 people on in the moment. So I think we can get started. Two. All right guys. Um Thank a big thank you to everyone who has tuned in. Um And also to Mr Assad Makbul, um who is one of um Sao at um Medi um NHS Trust. Um He's a clinic fellow in plastic surgery. Thanks for joining. Um So basically today, um again, we'll continue with the anatomy of the upper limb uh for those who were here last week, um who had the opportunity to join. Last week, we were um able to look at a few things. Um Last week, essentially, we were able to go through um the muscle as well as um the um bones of the upper limb um last week and we looked at some common questions, act in the MRC S um related to these things. Um And today. Um, we're looking at what I think is the most important part of the upper limb when it comes to, um, when it comes to the MRC S part A exams, um, which is, um, the innervation essentially of um, the upper limb. Um, I think is the most tested aspect of the MRC S um part A. All right. So, um, essentially, we'll be looking at the break, the racial plexus as well as all of the nerves that um emerge from the breaker plexus. Also quickly, just to do a quick look at the dermatome as well as the myotome, I should have added that. So as the myotome of the upper limb and then we just flash through the blood supply of the upper limb now, um just to retreat again, um the old essence of doing this is to look at the things that are relevant, particularly to the um MRC S part A um exams and, and I will essentially be looking at the things that will um that generally gets a very often. Um And we must, again, very importantly, it's very important for us to realize that, like I said, innovation is like a big thing. Um And understanding how different muscles act and behave is a very big part of um so sort of questions that we will tend to face when it comes to the MRC S um part A. Um And obviously, for those who are also joining, not particularly plan to take the example for general knowledge. Um These are quite very important information to have when you are examining patients. Um just to be able to elicit different form of um loss of function. Um And you'll be able to identify what nerves um could be the ones that are damaged based on um the particular clinical representation of the patient. All right. So getting straight into it, it is the breakout plexus. Now, a lot of people struggle to um understand how the breakout draw the breakup plexus. I think when I was writing my exams, I remember having to draw the breakup plexus in the exam all and having a quick um me to draw the breakup plexus is quite very important now. And that's why I've used this schematic diagram to sort of like illustrate um the breakup plexus. And, and this is quite important because um having this understanding or knowing these things will go a very long way to sort of like help. Um I think one of the biggest challenges um a whole lot of the time is that um people do not particularly um pay attention, you know, for example, on how to, you know, draw um the, the breakup flex. And I think it's a very good thing to have that information um on how to draw the breakups. Now basically extends in terms of the roots. And you can use this very simple acronym, real teenagers drink cold beer, the real, the harder stands for the roots, the T for the trunk, um the D for the divisions and then the C there for the cords. And then we have the B there for the branches. Now, the branches in this schematic diagram is not exhaustive for all, all of the branches of the breakup plexus. Um There are more branches to the, to the breakout brax, but we've looked at the terminal major branches of the breakup plexus. Now, you would see from another simple quote to remember all of the branch branches of the breakout plexus is um I think something I sort of like l um um in, I think it was in medical school. Um And I think it's a very, very good um It's a very, very good um code, you can use the word mam rule. So basically ma All right. Um All right, and that represents starting from the muscle cutaneous nerve, the axillary nerve, the median nerve, the radial nerve and the ulnar nerve right now, talking again just to quickly make a quick run through that. So, if we have the level of C five to T one. All right. And that's the, the common one. It's possible to also have C four to C eight in very rare occasions or you can have C six to T two ano another set of very rare occasions, but generally for most people, it is C five to T one. Now, um from the roots, the roots will come together. C 56 is come together to form the superior trunk. While C seven remains as the middle trunk and then C six, sorry, C eight and T one as the inferior trunk. Now, the trunks will divide into anterior and posterior. Right. It's quite important for us to remember that. All right, the, the trunks will divide into um the anterior and the posterior, the, the anterior of the superior and the middle trunks will come together to form the lateral cord. So the the trunks divide into divisions, which is the anterior and posterior divisions. And then remember that the anterior of the superior and the middle, both of them come together to form the lateral trunk. So it define from the lateral cord and then the posterior cord of the three of them will come together to form the post, sorry, the posterior division of the three of them, of the three trunks will come together to form the posterior cord. And then you'll have the anterior division of the inferior cord. So of the inferior trunk, all right, remaining as the medial cord. So you have the lateral, the posterior and the medial. All right. Remember the lateral is formed by the anterior divisions of the superior and the middle trunks. And you've got the posterior being formed by the posterior of the three trunks. And you've got the media being formed by the anterior of the inferior trunk. Right. Now, what you have noticed, you know that the posterior trunk, the posterior cord right, terminally will form the axillary as well as the radial um nerve um in terms of its branches, but it's, it's a, a very common or a very good cord that we can use at some point. And I think I will talk about it at some point um to remember some of these structures, right? Or, or remember all of the branches of the posterior cord is a code referred to a star. So star is a good code. S um can I write that SC E R? Right? That's a code that we can use to remember all of the branches of the posterior cord. And what are they? All right? Two of them are already represented here which is the A and the R which is the axillary and the radial. The other ones are the thoraco dorsal as well as the subscapular. So the subscapular, the thoraco dorsal, the axillary and the radial, these four nerves are all the terminal branches of the posterior cord. All right. So moving on. Um so we've looked at the, the brachial plexus in its broad sense. And this GMA diagram is a very easy way to remember how to draw it. If you practice it. It's quite, very easy to remember how to draw this. And this is quite important because in the exams, you will find questions, testing, you not just on specific nerves, but are testing for certain chords. And they are testing for certain divisions or sometimes even testing for certain roots when we begin to look at some pulses that are very common with the brachial plexus, right, moving on. So we've got um in terms of the location of the brachial plexus. And I think this is a question. Sometimes you get tested on in terms of where is the root of the Bracha plexus? All right. So the root of the bracca plexus is in the posterior triangle. All right. It lines between the anterior scaling and the middle sle. All right. So that's where you find the root of the Bracha plexus, right? And in terms of the trunk of the bracca plexus, this is located just posterior to the clavicle. All right. It is, it is located posterior to the clavicle. And we've got the three cords right, which is the lateral posterior and the medial cords. These cords, they are named based on their relation to the axillary artery because we'll find questions who will ask you that the cord or the breaker plexus are closely related to which structure, right? And the that there will easily be the axillary artery. All right. Now, again, these are simple bullet points. And uh this particular question of in, in terms of testing around the court was one of the questions I personally personally found in my exam, right. So it is quite very important to know some of these things, you know the locations of different parts of the breaker plexus, the root, the trunk and the court. Usually these are the ones that get tested in terms of their location. Um When, when we're looking at the bracer plexus, now it's also important to talk about some of the other minor branches of the um brachial plexus. All right. And um that's what we're looking at with this particular diagram, right? So this photo diagram talks about some of the other branches of the brachy plexus, right? That we've not sort of like talked about. And they include, you know, some of the other branches come from some of the branches that come from the root of the brachial plexus, like the dorsoscapular nerve. Um the long thoracic nerve will soon look at what those nerves supply. They are basically nerves that supply just a couple of muscles or some most times, just a single muscle. And then in the front of the trunk, we've got the suprascapular nerve and we've got the nerve to the subclavius or usually then their names tell you what they supply. So supra couple nerve basically supply the, this the um obviously, we're gonna see that very shortly, but just to give us that information, basically, su supplies the supraspinatus infraspinatus. Yes, thank you. All right. So it's quite very important to from their names. Essentially, we will be able to get um what they supply just like not subclavius, supply, subclavius, the lateral pe nerve. And we've got the uh medial pectoral nerve. We've got the medial cutaneous nerve of the arm. And then we've got the medial cutaneous nerve of the forearm. And in terms of the posterior cord, we've got additionally, we've got the posterior sub subscale. All right, which I mentioned earlier that we have two other nerve is supply that comes from the posterior cord, which is the suprascapular nerve. Uh Sorry, it is subscapular nerve. Um, and we've got the superior and inferior subscapular nerve and both of them supplies the subcapillaris. All right. So, and we've got the Tara dozen nerve. All right. Um Again, we will also look at what it supplies as we just move forward. Now, just to look at some of these minor branches and what is applied, the long thoracic nerve, you get tested quite a lot about it because they're gonna ask you about a patient who has presented with win scapula and usually it is the long thoracic nerve and that's due to because it supplies the cerato anterior. All right. I didn't, we didn't talk about these muscles because they are muscles of the upper back as well as um, the neck. And that's why a lot of these muscles here were not. We didn't particularly talk about them last week. All right. And when we look at in and neck anatomy, we would talk about some of these other structures now, um some of these other muscles. So the long thoracic nerve, um you get tested on that. Very few questions, test about the dorsal scapular nerve, um which supplies the labial scapula as well as the rhomboid major and minor. Very few questions that I have encountered when I prepared as well as in the exams that deals with that. But the thoraco dorsal nerve is another nerve that gets tested, which is um usually when you're talking about axillary clearance, um it is some of it is part of the nerves that can be damage during axillary clearance during bras and sometimes you get tested on that. Um The other one here is suprascapular nerve, not particularly II didn't see a lot of questions testing on that, but it's just good information to know what these nerves are and what this apply. All right. Now, moving on to some of the important clinical points when it comes to the breaks. Um One of the things you must remember is two types of pulses, the heps palsy and the clone cases, palsy. Now, one of the ways I extend to remember, um which is which, which you can also use that if that would help you is how do you remember he before K? All right. E before K. So that's an easy way to remember. And what does that? He before K means it means that heps power which starts with E all right, when you look at your alphabet. E will come before K. All right. And E that represents the, which is Heps policy. Talks about injury to C five and C six. All right, which is a superior trunk. While the clunky palsy, which is lower in your alphabet, which is K. All right. Um represents injury to C eight and T one. All right. So it is good to remember that. All right, sometimes. And like I mentioned to you last week, once things are opposite of each other, once you are able to one of them, if you can always remember that E is same thing as you can use E for early. And if your brain remembers that oe is early, um SAR is early. So it is the first set of cords that it affect. So it affect the, the, the superior cord, which is um it's the upper trunk. Um So it, it, it affects C five and CC six. Then that just helps you to remember that invariably the con is gonna be the lower one and it's gonna be CC eight and T one. So whatever helps you to remember, but it helps you. I, you know, sometimes you don't want to be remember but you are confused and you've not got anything to help your memory. And I think EB four K is a good way to remember um when it comes to um else policy as well as um policy now. But in terms of some of the clinical presentations because sometimes in the questions, what you would get at a clinical presentation are not particularly um they will not even mention s palsy, they will just talk about patient that has got this, this and this and this. Do you think it is the upper trunk or do you think it is the lower trunk, whatever it is? Because you remember um some of the things that would happen now, so if you go back, if we go back, for example, to you, um the brachial plexus, and we look at some of the things that come up from the upper trunk would realize that the up the superior trunk, right? C five C six produces the musculocutaneous nerve. So it means there is an injury to the upper upper trunk or the superior trunk would definitely have loss of function of the mus cutaneous. We would also realize that that same superior trunk gives some branches to the medial nerve. And you realize, you realize that you also basically, it is the musculocutaneous as well as the median nerve. Essentially, you will find them being affect, of course, the median nerve not completely because you also receive some supply from the medial court. But you realize that the musculocutaneous nerve uh nerve as well as the median nerve are the ones where there will be loss of functions when it comes to the superior. Now, that's why it's good to understand the diagram. And to understand where things are arising from and what fibers are contributing to make up what a particular nerve that goes a long way for you to be able to identify some of the things that happen. So you, you realize that the deltoid is affected. So the deltoid, so I with Bell's palsy were going to have um we're going to have s in terms of the, to be able to raise the hand, particularly your body. Um that's going to be lost, the suppress paralysis. Um Well, and that's because of the long thoracic nerve who basically comes from. Um So if you talk about the long thoracic nerve, for example, that basically arises from C five C six C seven, right now, some of the other functions that lost are loss of external rotation. So external rotation in terms of infraspinatus elbow flexion in, in terms of the biceps, um um as well if your radialis now, um also ation, which is majorly being played by, by and this particular post posture posture, as you can see in this diagram. And if you remember that at the back of your mind, it helps you to always remember what things will look like. So it's an internally rotated, a adopted hand, so irritated a hand, a deduction, all right, and extension, we're gonna have extension at the elbow and forearm, right with flexed wrist for that. And you remember about it in your head and you'll be able to identify some um that most likely would have been done with when you to the exam you'll be able to um figure out that it is housing. Now, the comp on the other hand, basically, um talks about loss of sensation over the medial hand as well as the foreham. All right. One of the things again with it is also look at um a as well as the loss of flexors of the wrist um and also claw hand which is mm CPG extension with I PJ flexion. Right. Again, we can see that diagram and that helps for you to remember that claw hand. All right, that's what you expect you get with um clon palsy. Now talking about Honor syndrome. It's just one of the things is worth me mentioning um because it's quite complicated and it's outside the scope of our conversation today. But basically, it has to do with the, the Oke pathways um which is made up of three basic cell of neurons. And um in terms of the order of neurons because of the first order neuron, the 2nd and 3rd order neuron. But a particular order of neuron that is affected here is the second on neuron which received contribution from T one, right? And so damage to um C eight and T one would mean that it damage to the second other neuron that contributes to that three to the sympathetic pathway. And that's what's responsible for the Honor Syndrome. But just note that that one of the things that can happen with clon case is Honor Syndrome and one of the ways so a very easy pneumonia for it is PM, which is expos, there's an addresses and right, this is a different conversation. The Honor Syndrome itself is a important subject to read for the MRC S, but it's not covered within the scope of anatomy. This particular anatomy we are looking at today. Um but it is a very important um information to know it's very subject to read about um for the MRC S now. Moving on. We're going to, sorry, I'm interfering. Uh Yes, I just wondering, shall I submit the some of the things in the end or shall we divide the whole presentation into three parts? You have covered brickle taxus. So, well, you have mentioned almost everything. But shall I add a few pointers for the brickle taxus? And then we go on to the peripheral nerves and then to the neck? Yeah, that's fine. Yeah. Can you go to the first slide quickly and let me just add a few quickly uh clinical bits to it. The practical bits just go to the first slide. Yeah. Can you go to the first slide quickly? This one? Uh it start changing. It's still on Horner Syndrome for me. Is it this one the first, the first year? Second year, this one? This one. Stay here. Stay here. Yeah. Yeah. So, yeah, guys. And at me definitely for the Brickle, it is quite complicated and on top of that, unfortunately, you have to cram it. Uh Either you see it in a physical human being, well, if you are pricking surgeon or you have to cram it and, but I'll, but I'll just try to simplify the things a little more and just try that. Uh, but uh Gabriel has already covered all the important bits for MRC S. However, what I really want you to uh think is Brickley taxes as upper Brickley taxes, lower Brickley taxes and pan Plexus just imagine that these three, these three entities are the important bits that you have to remember. So because there is a reason that you are asked certain questions in mrcs and all of them are related to practicality in the patients. That's why you, you guys are asked those questions. So number one is the upper ba ba. So somebody would have an upper ba ba injury when they have got C five C six too damaged. What that would mean for you guys is musculocutaneous and axiliary. They are definitely gone. What that means is something that is around the shoulder and above elbow and around the elbow that's not working. And then somebody may come to you with lower brachial plexus injury, that's generally C eight and T one and that would be a and median nerve most likely. And that would mean that the hand is not working and the forearm is not working. And then there can be third entity which can be pan plexus that all of these are gone and any of these mixed nerves are not working. So when it's upper ba plexus musculocutaneous, just think in your head, what's not working? It's the biceps that's not working. Flexion is gone. What axillary is not working. It's the deltoid shoulder abduction that's gone. So just now fast forward herbs pull out paralysis. That's the upper brittle plexus injury. That's C five and C six. Just think in your head. C five, C 60 What I'm thinking? Musculocutaneous and axillary. And there may be some bit of the radial as well because radial is an overlap, radial nerve root is C five to T one. It takes a supply from all of the nerve roots, but musculocutaneous and axillary are purely upper ba bas so s is an upper ba vesel injury and which would mean he cannot abduct his shoulder, he cannot flex his elbow. And because of that and some of the nerve is also gone. He cannot extend a few things. His arm is kind of rotated inside and flexed. Whereas klum case, which is a lower flex injury, it is more affected into the hand itself. So he can't flex his mcps, he can't flex his fingers. And because of that, the radial nerve is working, it is overactive, it is extending the mcps, it is extending the wrist, but the shoulder is fine. So upper and lower ba ba is divided into that and that kind of gets you into the head into your head. That some questions also. So that's why Arbs Arbs is upper ba pax muscular axillary and some of the radial and case is lower ba paxis, ulnar and median and the hand. Yeah. And you just go forward to the few other slides, the uh minor branches. OK. Minor branches. Yeah. Yeah. Let's see here. So for the minor branches as well, the few questions that you guys generally asked are either the lateral pectoral nerve and the middle peter nerve. These two, these two, the reason is the supply, the pectoral is major and measure is one of, of the muscles that can be used in certain situations where we reinnervate the other muscles. So that's why you guys are. So you have to remember these two branches that are coming from minor branches that are coming from the recti plexus that may be in fact or may not be similarly. Thoracodorsal is the other nerve that you are always asked in the exam because lead dorsal is the muscle that is applied by the throar and that may or may not be intent. It's very critical. So remember throar left dorsi little pectoral, middle pectoral tact major. These two nerves are very important here which you have to like cramp. I'm just, I'm just throwing the pointers that you have to cram in your head that the questions are generally asked in the, in the EMC as part the exam. Yeah, moving forward to the next slide. So we s and amp again, upper and lower back back injury, which means what, what would be gone, which is mentioned here. And because of the reason that I've just told of the nerves that are primarily affected here. Yeah, I'm going to be to the, to the nerves, no peripheral nerves. Yeah, I'd say quiet now and you can move on to from here. All right, thank you. All right. So um thank you very much assad for um that um and this is really nice having you to today um to have all that, that extra information. All right. So um looking at the musculocutaneous nerve, this is um the first nerve, one of the nerves that we talked about the, where we looked at the breaker p um coming up from that um you know, um from the roots, basically nerve roots of C five and C seven. Now, in, in terms of its functions, it supplies the muscles of the anterior compartment, which is which all I'm sure most of us can remember as the BBC. All right, the brakes, the brachial, um the, the, the braca, all right, the coracobrachialis now as, as well as the biceps bracers. So it is quite important to remember these three muscles, all right. Um And because sometimes you get tested um along the lines of um some of the functions of this. So you could be um loss of flexion at the elbow and then or loss of supination because the biceps breaker plays a very major role in supination. And because of that, sometimes all you'll be asked is loss of function on some of this muscles. And then you react to what nerve I do you think is most likely damaged. So it's quite very important to understand or to remember the nerves, sorry, the muscles are supplied by this nerve, right? Just like the name sounds musculocutaneous. It supplies both muscles as well as it also supplies um the skin. So it gives a cutaneous supply. All right. And it is also referred to as the lateral cutaneous nerve of the forearm. So, whereas its muscle supply is in the hand, in terms of supplying the anterior muscles of the hand, it's um cuttin supply is in the forearm, supplying the lateral side of the forearm. And this is just quite an important information to remember now. So this diagram basically just shows all the um musculocutaneous nerve, which we can see here. Um And we can see it's given off um that lateral branch, all right, that goes ahead to become um the lateral cutaneous nerve. Now, one of the things again, it's quite important to remember um is the fact that the musculocutaneous nerve pierces through the coracopis muscle comes out from it. All right, to make it supply to all of the three muscles that it supplies and then travels downward to then give us that lateral um cutaneous nerve right, that supplies the the lateral side of the forehand. Now again, this diagram basically just highlights the sensory supply of the musculocutaneous nerve which is on the um lateral border of the forearm. Now, so basically talking about musculocutaneous. Always remember it is a muscle. It is a musculocutaneous because supplies both muscles and as well as it has a cutaneous supply. And for the muscles, it is the BBC which has the three muscles of the anterior aspect of the ham. And then it supplies, you know, it gives a cutaneous supply to the foreham. Quite, very simple, quite, very easy to remember a nerve and the things that it supplies right now for the axillary nerve. Now, this is one of the nerves that we spoke about very slightly last week. And in terms of some of the places where we can find it and some of the places where it tends to place functions we look at very shortly but a as as worth of notes, again, it's got ac five and ac six root, um very similar to the musculocutaneous nerve, which also has ac five C six root, all right. And then it gives rise to um the upper lateral cutaneous nerve of the hand and also um gives innervate the skin over the lower deltoid. Also can be referred to as the regimental patch area and then its muscle supplies the terra vinyl as well as the deltoid muscle, right? And so some of the things that you very easily to remember is that it plays a role all in the abduction, the api duction of the ham because it supplies the deltoid muscle. However, it's quite, very important to talk about this. Um, because, um, one of the things that get a, a lot is some of the places where you can find a bit of the Axillary nerve, which we talked about when we talk about the Chondr space last week. Um, trying to see. Unfortunately, I didn't even put a picture of that here, but it, um, if you can look at this particular diagram, we will be able to appreciate some of the things we talked about when we talk about the Chondr glass space. And we talked about it being, being formed in terms of um, some of the borders of the Chondr Glass space, which we talked about um, quite nicely uh last week. Um And it's, it's important because one of the content of the chondrula space is the axillary nerve. It goes through that and then spins around the head of the surgical neck of the humerus. And this is also important clinically because fractures are the surgical neck of the, of the um humerus. Um One of the nerves that can easily be damaged is the arti nerve because it finds its way around there and it can easily be damaged when there is a fracture, a connected humerus. And then it also gives a cutaneous supply over the skin just inferior to the deltoid area called the regimental badge area. So in terms of the deltoid, remember the three muscles, it supply supplies the three parts of the deltoid, um which is the middle, the anterior and posterior part of the deltoid. He also supplies the terrace minor, quite very important to remember that. So right, so these are, these are two muscles, the deltoid and the terrace minor. And then he also gives some cutaneous supply. All right. And it's very, very important remember that it, it gives the upper lateral nerve of the hand, all right, which innervates the skin over the delt over that lower deltoid area called the regal badge area. All right, moving on from the axillary nerve. Um Again, this is just a skin mark diagram telling us this cutaneous supply of the axillary nerve then is the median nerve. Now the major nerves that get really tested is the median nerve, the radial nerve as well as the ulnar nerve. In fact, I in reality, it is the medial and the ulnar nerves that are majorly being tested in the exam. And that's because they've got so many aspects to them. And it's so important to understand the various aspects to the median nerve as well as the ulnar nerve Now, in terms of the median nerve, right? Um It, it is root, its root is C six and T one. also get some fibers from C five in some individuals. Um But generally it is C five, say it is C six and T one. Now it's muscle functions um which is quite, very important to remember. Um is to remember that it innervates all of the flexors right in the anterior compartment of the forearm, as well as the pronator. So it innervates all of the flexors and the pronatal muscles in the anterior compartment of the forearm. All right, with the exception of two, all right. And it's quite very easy to remember the two muscles that it does not supply and the two muscles it does not supply are supplied by the ulnar nerve. All right. So when we look at the anterior compartment of the hand, if there's any muscle you, that is being thrown at you, that is in the anterior compartment of the hand, your first instinct, your first guess should be that it is supplied by the median nerve with the exception of the flexor copy or, and that's quite very easy to remember the fact that it bears the word orna. So it's supplied by the nerve, all right. And then the lateral part OK? Of the flexor deter per is sorry, the lateral part of the of the FDP, all right is being supplied by the median nerve. However, the m medial part of it. All right, the medial part of it is being supplied by the ulnar nerve. Now, don't confuse that the, generally, you just have a little bit of your mind to say that the ulnar nerve is a little bit mo medial. And when we look at the course of the ulnar nerve, we'll see that it's quite, very medial in its course. Um and, and the the median nerve on the other hand, tends to be to be more lateral. So you can have that slightly in your head, all right, that the median nerve is slightly lateral and that the ulnar nerve is sort of medial, all right. And so when you look at it in continuous distribution, you would realize that I the median nerve is lateral and the ulnar nerve is medial. So you have that fail at the back of your mind. Now, so when it comes to the flexor per induce this particular very big nerve, so big muscle has to not supply, it's got the lateral side being supplied by the median nerve and it's got the media side being supplied by the ulnar nerve. Don't be confused with the word media nerve thinking it is, it supplies medial, all right. It's not, it is, it supply is actually sort of like lateral, right, just have that kind of thing in your head. And that's quite also important when we look at the lateral Truls, which are also being supplied by the median nerve as well as the tal muscle. So remember this, when you're trying to remember, um, the media of supply, when it comes to its muscles, it supplies all the flexors and pros in the anterial aspect of the forearm. With the exception of the FC, which is the flexor cap on and as well as the flexor digita profundus, it does not supply the medial aspect of this muscle. It also, when it comes to the hand, it supplies all the thinner muscles, which is the muscles of the thumb. Essentially the thinner muscles, you know, basically are the policies, muscles. Essentially. We, we talked about that last week as well as the lateral to Lumb breakouts. Now, once you remember that, I think one code, some persons use for it is the code called Lof. Lof. Um And I think it's an easy code that you can remember. OK. Um Lof um L or E F uh talking about the muscles that are supplied by the median nerve in the hand. All right. So in the hand lobe, which is the lateral Trumbo, the o represented the um opponents policies, the A represent the abductor policies, Brevis as well as the flexor policies, Brevis, right? So if you remember that and, and then that's, that's, that's just quite, very easy for you to remember all of the muscles that it supplies in the hand, the lateral and the O AOA F which are the muscles of the TNA eminence, correct? Haven't talked about that, right. This is just to give us that, you know, broad understanding about the median nerve. Now, one of the things that is quite, very important to talk about is the cause of the median nerve, quite very important. Now, it is important because we get tested on the cause of the median nerve and maker cause of the median nerve, right. So basically when it comes from the brachial plexus and the axillar, it descends down the hand, initially lateral, right, lateral to the brachial artery. And then it crosses over anteriorly, all right, crosses over the um brachial artery and then goes to the medial side. So one of the questions I guess we ask is what is the relationship of the medial nerve to the brachial artery? And always remember the word lamb, lamb. Remember lamb A L am it is initially lateral, becomes anterior and then becomes medial to the brachial artery. Remember that lateral, anterior, medial, lateral, anterior, medial, it's a very common question that tends to get axed. Now, in the foreham, the nerve travels between the two s of the pronatal terrace and then descends into a plane between the flexor deter pers as and the flexor deum superficialis muscle. All right. So remember that in terms of the cost. But the major part thing to remember when we talk about the cause of the median nerve is to remember its cause in terms of its relationship to the brachial artery. I think this is quite very important for us to remember. All right, having said that, all right, we can move on to um it continue in terms of it course, talk about what happens once um the nerve begins to come down. So we talk about um some of the the branches of the median nerve. So um it it's called the anterior inter nerve, all right, which is a branch of the median nerve as well as the palmar cutaneous nerve. So these are the two branches that it gives off in the for her, right? It's quite important to remember the anterior inter nerve because so many times you get tested on the anterior inter nerve. And one of the ways you get tested is that they mention some other muscles that are supplied by the median nerve. And they ask you, you know, for example, they can ask you about the prenatal contractors. Now, the prenatal quadratus is supplied by the median nerve, but actually, it is supplied by the anterior inter nerve, that branch of the median nerve. So there are questions where they will ask you what supplies the prenatal quadratus. And the options would be, you know, they will release almost all all of them options. We the options, we include both the median nerve as well as the anterior inter nerve. All right. So the question is, so what is the answer? Right? So it's important for us to remember there are three, nerves, oh sorry, there are three muscles that the anterior interns um nerve supplies. He supplies the PQ, which is the peral contractors. He then also he, he, it also supplies. Um So remember PQ remember that I supply it is, it is the branch that supplies the lateral part of the FDP. And then it also supplies the F cr. Now that is the, that is the flexor carpi radialis. Now we talk about the flex, the FC U which is the flexor carpi ulnaris, which you said is applied by the ulnar nerve. All right. However, the flexor radialis, all right is supplied by the median nerve and the branch of it that supplies it is the anterior inter nerve. So three structures supplied by the anterior inter nerve. Quite, very important to remember is those two things. Remember the FCR. All right. F CR remember D PQ. All right, which is the prenatal quadratus and remember the lateral bit. All right of the FDP. All right. So remember this because you can get tested on that. And then when, when they're asking this question, so you don't pick the median nerve because that will be, that will be a wrong answer because you will find both the median nerve as well as the anterior nerve in the options. Um And just to remember that is that he supplies the deep muscles of the anterior forearm and these are the deep muscles of the anterior forearm. All right, going on. Um, he also has it terminates into two branches, which is, and it's important for me to talk about the palmar cutaneous nerve. And that's because um when we begin to talk about the copper. So the carpal tunnel syndrome, we realize that the palmar cutaneous nerve, all right is given off. And you can see that in the schematic diagram here, the, the, the, that's the, the um palma cutaneous branch is given off just before the median nerve goes into the carpal tunnel. All right. And before it goes into it, it gives all it gives off the palmar cutaneous branch. And that, that ensures that if, if de so in carpal tunnel, we do not have loss of sensation over the area that the median nerve supplies in the palm. All right. Um And that's important to remember because when we talk about the carpal tunnel syndrome, all right, moving on, there are two other branches where it terminates, which is the recurrent branch that innervated 10 muscles as well as the palmar digital nerves. All right. And we will talk about this because that's, that's where it supplies the lateral trons, um which are the only two intrinsic muscles of the hand um as well as the, the t um muscles that it supplies. Um And then it also gives a cutin innervation, which is that it supplies the power aspect of the lateral 3.5 of the fingers. And we'll look at that as we um move on. So these are the three muscles um just to retrieve them again, that the anterior inter o nerve su supplies, which is a branch of the median nerve. All right. It's quite important to remember this because most of more than know we get tested on this. All right. Moving on, this is uh the um sensory supply of the median nerve. And we it's very important to remember the palmar aspect of it because like I said, that usually gets sped even when we've got um the carpal tunnel syndrome. All right, or when we've got a damage um to the um median nerve um that is happening at the wrist if that is happening, you know, before it gives off the palmar cutaneous branch, um that will be spread. All right. Just important to remember that. And to remember the other part which is the lateral um 3.5 of the fingers on the palmar aspect. Obviously, you can also see that there is still that slight extension over the dorsal aspect. Very ea right? That's also important to remember, right? Haven't said that. Ok. Moving on. Um Some of the things that is worth remembering. All right, is your pressure with the carpal tunnel and there, yeah, some of the things could be more talks about it is worse um at night and things like that. Or early mornings, we can talk about that later. But really what we're talking about here in terms of the anatomy. All right, is uh the fact that um what are the things we expect? Um In carpal tunnel syndrome right now, we'll talk about if I got a palm expect. And that's because of the power continous branch which does not travel through the carpal Tonel, it is given off before it. So it's very important to remember that. And so we expect that the things you expect to happen are the structures that are supplied by the um median nerve after it goes through the um Kappa 12 L. All right, which is the tin muscles as well as the lateral to lumbrical and the continuous supply. All right. So these are the things that we expect to essentially be affected. All right. So we expect some numbness or numbness to the lateral 3.5 of the hand of the, of the fingers. We expect that the palm expect because that's applied by the palmar cutaneous branch. And we expect that it will be wasting all right or atrophy of the tile muscles, right? That's quite important to remember. All right. Well, and some of the ways to test it because they can ask you that tensile test test for what? All right. Remember that test. All right. Um It's basically licin the media nerve distribution and that basically involves tapping. You can see on that diagram and wide balance test. Also basically, um there will be um numbness initiated or pain along the distribution of the median nerve when you flex um the um wrist joint, right. So obviously a all of these things are just things that will sort of sharply um for increase the tightness of the carpal tunnel and that, that will further ece the symptoms that we expect from the median nerve distribution. Now, some of the things again, important to remember are lesions to the median nerve. If the damage is happening um at the elbow or if the damage is happening at the wrist. All right. Again, if the damage is happening, how the help or we expect that v all the functions, all right, most of the functions of the um median nerve is gonna be affected. We expect that the apparent price of all the flexors and the pros with the exception of the FC U as well as the media half of the FDP because these are supplied by the nerve. All right. One of the things again to mention is that there will be adoption of the wrist. And the reason for this is because um the F cr which is supplied by the, this is the flexor Cy Regis um which is supplied by the median nerve will be lost. And so the FC U which is supplied by the ulnar nerve is still intact and I will pull the hand. All right, it's gonna pull the hand to the media side and so he's gonna pull the wrist, sorry, he's gonna pull the, it's, it's gonna cause that abduction, sorry, a deduction at the wrist, um pulling on the medial side, all right, um causing a deduction. Um And so we expect that um at the wrist, obviously, uh lateral true long break out will be affected. Um And the patient will not be able to flex the M CPJ or extend the I PJ of the index and middle fingers because those are what will be affected as well as the t um eminence who will be wasted. All right. So be wasting all the t eminence. So it's quite important to remember these things. However, the little finger as well as the ring fingers, those ones will be completely flexed and that gives us what we call the benediction sign. Um because when you ask them to make a fist, um they will be able to flex the little and the ring fingers because this is essentially being controlled, don't forget that is being controlled by the media nerve where the medial. So it's being caused by the ulnar nerve where the um FDP, um the medial part of the FDP, which is controlled by the ulnar nerve. Um So we can, we expect that the function of the little as well as the ring finger will be, will be unaffected, but that of the index as well as the middle finger will be affected, right? Um Because of time just to move on um damage at the wrist, we expect that that's gonna affect essentially the structures, right? That are um me enough supplies in the hand, which is a thinner eminent, as well as the lateral to Lumb break out. Um We just look at the ra now very quickly. It's a very, um not the most complicated of nerves, it's quite, very straightforward. And in terms of the things to remember about it is that it provides sensory supply essentially to the posterior forearm um as well as the lateral um aspect of the dorsum of the hand because the medial aspect of dos of the hand is being supplied by the median nerve. So it is already on. Um And then it also worth us remembering the fact that it also supplies um the doss half of the lateral tutored of the hand in terms of its muscular supply, always remember that it supplies um the brachial radialis, all right, just as the name impairs radialis. But remember that the F cr which is the flexo radialis is not supplied by the radio nerve, whereas it is supplied by the median nerves don't be confused by the name to think that it's supplied by the radio nerve, it is supplied by the median nerve. All right. So in terms of the um other things apply to the breaker radialis, try the extenso, he supplies the super natal and he also supplies the triceps, right. And the code for that is best, best. All right. B est. All right. These are the things that it supplies. Um, we'll talk about the cause of the radial nerve and that's quite also important because, um, it passes through a radial groove in the humerus. And if we've got a, um, midshaft or even a proximal fracture of the, um, er, this, this could mean that there is injury to the. Um, so you've got a fracture of the humerus, um midshaft or upper midshaft. Um, w we would realize that there could be a damage to the radial nerve that passes through the radial growth of the humerus. Alright, go moving on. It's quite important to realize um that we'll find it within the triangular space, which we also talked about last week when we talk about the triangular as well as the contra space. But the radio nerve all would exit the axilla via the triangular space, which we talked about last week. All right, and supplies the long and the longer the lateral area of the triceps and then comes slightly down to then supply the medial of the triceps. All right. Um It is in its course, it is um is accompanied by the deep branch of the brachial artery. Um That particularly doesn't get tested. What really gets tested is a relationship with the median nerve to the brachial artery, which we talked about earlier. All right. Um When it gets to the elbow, it travels anterior to the lateral epicondyle of the er all right. Um And then it terminates dividing into the deep, as well as superficial branch. Now, in terms of the radial nerves, container supply, this essentially shows the distribution of that it supplies that lower part. Um Essentially. Um So, whereas when we talked earlier, we talked about the axillary nerve providing some lateral um contain supply. But that's or later oxygen supply of the, of the ham. But the radio nerve provides the lower oxygen supply of the ham. It also provides a lot of the um posterior continuous supply of the ham as well as that of the forearm. And he also does that when it gets to the hand, also providing um on the um lateral t three to the lateral 3.5 um of the hand it provides on the dorsal part, it provides the cutaneous supply. Um One of the commonest thing you will find with um, injuries to the radio nerve, which is commonly tested is the wrist drop. Um, when it comes to the radio nerve because that it plays role in the extension of the, it supplies the extensors of um, the wrist. And so if the extensors are gone, um, what we expect is that the hand would be pulled into flexion. All right. And that's what causes the rest drop. Now, the other nerve is another is the other big nerve that we need to talk about because of the various aspect of it. And I'll be right out quick now because it's already 7 p.m. All right. Er, at, is here in the UK. Um, it's spinal root is C eight T one. All right. Um, and we have two muscles of the anterior forearm. Um, that it supplies, which is, which we already talked about, which is the FC U as well as the middle half half of the FDP. We've talked about this well enough and it supplies all of the intrinsic muscles of the hand, except the tenor muscles as well as a lateral l lateral lumber. So it supplies all the intrinsic muscles of the hand with the exception of lof right, which is supplied by the median nerve, which we talked about already earlier. All right, in terms of sensory supply supply is the medial 1.5 fingers and it does its own supply both on the buller side as well as on the dorsal side, all right, of the medial 1.5 fingers, right? And the palm palmar areas. All right. In terms of the cause of the um median nerve, all right, it descends between the axillary artery. It's lateral to it as well as the arti vein, all right. So it does arteries light to it. Um while the um axillary vein is medial to it, um it passes posterior to the elbow. Um and then you'll find it there, um, via the on tunnel, a small space between the middle like condyle, as well as the, um, in the foreham, the nerve pierces between the two heads of the FCU and travels deep to the muscle along the ulnar. All right. So, like I mentioned earlier, you find it very much on the ulnar side or on the medial side, right? It's got three branches. It's called a muscular branch supplies to the FC U as well as the medial part of the FDP. And then it's called the palm contain part that supplies the medial half of the palm. And then it's got the dorsal container brand that supplies the medial 1.5 um of the fingers as well as dorsal area of the end. All right at the wrist, it travels superficially um to the flexor um retina column, whereas the the the the medial um artery, so the medial nerve right passes um deep to the flexor retinaculum into the carpal tunnel. E part the ulnar nerve is superficial to the flexor retina column. Now, a very common question questions that gets very tricky is the relationship of the medial. Um uh Do you could do you usually about the ulnar nerve to the ulnar artery? All right. So it is medial to the ulnar artery at the wrist. Remember that it is medial to the ulnar artery at the wrist as it enters into the ulnar canal. Also referred to as the Guen's canal. Now moving on the ulnar nerve in the hand, like we said earlier, it supplies all the intrinsic muscles of the hand. With the exception of the lateral true lumbar go as well as the muscles of the tenar eminence, but it provides supply to the apo tenna muscles, which is again, we talked about that last week and we said the code again is ofa the opponents digiti mini mean, the flexor digiti minimi Brevis as well as the abductor digiti mini. Mean, it's quite, very important to remember that. All right. So he, he, he supplies all of the muscles of the ti as well as the media. S supplies, the adopt policies. All right. And you must remember that that's like literally the only muscle of the thumb. All right. That is supplied by the ulnar nerve. And that's the abductal poly. And we'll talk about that when we talk about the sign, which is one of the things you test for when you're trying to check the function of the, on a nerve. All right. So, um, the Abdo policies supplies the both the entire shows the palma dot which we talked about last week, the pad and the da I will talk about Palma being three and Dozol being 4, 3/4. Um, some of the things we talked about last week. All right. Um, also it supplies the Palmaris Brevis. Um, and the exception is quite important to talk about this because, um, whereas, um, it is the deep branch, it's by the deep branch, all of the muscles of the hand as a by the deep branch. So barfi branch of the ulnar nerve supplies the palmaris brevis. All right. Um, in terms of the essential supply, we talked about it already, but this is just to give you schematic diagram to illustrate that even further. All right. Now talking about the nerve palsy. Er, all right. Um, it's quite, very important to talk about it because he has, um, we get tested a lot about it based on the, the injuries you find at the elbow compared to the ones you find at the wrist. Right. So if the ulnar nerve is damaged at the elbow, it, it looks like the, its effect is not, um, you know, its effect looks more severe when it's damaged at the elbow vessels, you know, when it looks less severe vessels when it is damaged at the wrist. But again, we look at some of these things, um, as we go along. So all the muscles that we talked about, um, that innervated by the ulnar nerve are affected. All right, when there is a damage at the elbow. All right. Um, the flexion of the wrist can still and that's as well because, um, and that's, that's because don't forget that it is not the major flexor. Uh, the risk, it only supplies the FC U as well as um the medial part of the FDP Sir, um essentially a fraction of the risk can still occur. Um but there is accompanying a deduction. All right, whereas for the median nerve, so there will be a deduction and that's based on what is affected, which is the FC U here. Whereas when it comes to the median nerve, which is the F cr All right, the other thing we talk about is the abduction and the abduction of the fingers, which is controlled by the entire cell and the entire cell is supplied by the ulnar nerve. All right. So one of the things you realize is that these patients cannot hold a piece of paper between their fingers, right? Because they are unable to duct and I duct to their fingers. All right. Now, the other thing you talk about is the movement of the 4th and 5th fingers is impaired. And that's due to the fact that the middle two long break hours is affected as well as they don't also forget that the, um FDP als also basically supplies, um, the, the medial FDP is also affected, which is supplied by the um, nerve. And then we'll talk about the fact that the a deduction of the thumb is impaired. All right. So, um, which we talked about that, that's the only muscle of the thumb that's applied by the, the nerve, the ad which is the abductal po All right. In that sense, I think we talked about that already and I've talked about some of the car I sign is that was wasting of the apo a and patients are unable to grip, you know, um, paper between your fingers and that's because of the loss of function to the entire side. Um, as well as a positive from a sign which we'll look at very shortly um, as we go on. So this is basically the, from me sign testing the ad doctor. All right, which is the abductor, sorry, the ab doctor, the ad doctor of the Tom. All right. So um the question that can be asked is from me sign is testing for what is testing the abdo? All right. So what happens for these patients is that the normal when it is negative means that patients can afford to keep their hands a abducted. And last week also looked at what are different movement of the thumb. We looked at the, we look at the abduction of the thumb, the abduction of the thumb, the opposition of the thumb as well as the flexion and extension of the thumb, which we looked at last week. All right. So in terms of the a deduction of the thumb that is gonna be lost um when we talk about it from xi um so a patient is not able to abduct, abductor, abduct properly. Um And that's what's responsible. And what happens is PPM begins to flex the pump to be able to um at the I PJ to be able to initiate that. That's the response to be able to order paper PM begins to flex because they are unable to maintain a deduction of the thump. Now, in terms of the nerve paralysis at the wrist, right, what happens here is that it is only the intrinsic muscles of the hand that are affected. Um And here, basically, we've talked about intrinsic muscle of the hand, the inter the um doctor of the thumb, as well as the l the ll, the lumbrical, the foot and the foot, as well as the apo muscles. Just very important to remember this. No. So this basically is talking about, basically talk about the general things to remember when it come, when, when we talk about the major nerves of the upper lip. All right. Um I'm sorry, I didn't know if you wanted to have any information at this point. And again, uh you have already covered the main median and the nerve which is most asked. Uh just a few words again, uh It is again the clinical scenario that uh that all the s are made on. Uh for instance, whenever there is a question on the median nerve A I is a pure motor nerve A I is a pure motor nerve. So whenever they would ask you a question, the reason is there is a pro syndrome and there is a, a syndrome. So pro syndrome is when median nerve gets compressed in the forearm. And that will mean motor is lost and some sensory is also lost, which is the finger sensory. Whereas when there is just purely motor loss, the question would always be there is a patient who has had a compression who is having, who cannot flex or who cannot do something, but it will be purely motor loss. And the answer would be a uh whereas when there would be a question, where is there some talk about the median nerve, palsy or median nerve problem, but the sensory component to it as well, and there will be a median nerve. That's the answer, not the a a but getting more into the spastics of it, just imagine the visualize the forearm and the anatomy. Again, when the median nerve comes from the brachy plexus goes into the media sort of the arm and then crosses the elbow. It does not supply anything in the bicep area in the arm. All it supplies is the forearm and the hand and the first muscle in the forearm is the perimeter PT. So PT is the only muscle important muscle in the forearm that's supplied by the median nerve. And once that's supplied, the rest of everything gets supplied by the e with few exceptions, the most superficial muscle in the forearm, palmaris, longus, not a useful muscle, never gets asked in the exam. So that's why you don't need to focus on it. But that's the superficial muscle also supplied by the median nerve. But essentially PT per is the first ever muscle in the forearm gets supplied by the median nerve. Once it crosses that, then everything else motor wise is mostly in the motor nerve. And the other thing about the ulnar and the median nerve in the hand. So always remember ulnar nerve intrinsics, ulnar nerve intrinsics, all the intrinsics in the hand supplied by the ulnar nerve. With few exceptions, the few exceptions are number one thar eminence because that's on the radial side, that's the median nerve except the thar eminence rest almost everything by the ulnar nerve. And when we talk about intrinsics, that's the intra we are talking about. So all intra intrinsics of the hand by the nerve, the thin by the median nerve. But there are exceptions which has already talked about. But all I'm pointing out is the reason you get these questions asked in the exam are because they want to differentiate that, that which lesion is the nerve, which lesion is the median nerve. I, well, I II hope I'm making it a bit clear. Uh And I'm I'm just trying to summarize and just so that you can get in your heads at why the questions are asked. Thanks. Yeah, we can move on. All right. Thank you very much, Asad. Just um as we're ba basically coming to the end, um we're almost done. Um So in terms of the blood supply um to the, this is a very good schematic diagram. If you can show your screen to, to use this, this is very good. It just gives you a floor um to understand what would you, what would ho how we get the blood supply to the hand um or to the upper limb generally. Um And to be fair, um there, there's not a great testing really of um when it comes to the blood supply of the upper limb, it's not greatly tested, but it, it is good information to know it's good information to remember. Um Obviously there are other blood supply that is greatly tested. Um When we get to anatomy of the abdomen and things like that, we find the law of that being heavily tested, but when it comes to blood supply as well. So first of all, the o that's not greatly tested in the exams. Um But what you have noticed, remember, you know, how things are progressing. All right. So from the, from the aortic arch, um we have the, the way I try to remember it is the BSE. All right. Uh BSE. Um for those who probably know who are from countries where people get degrees called BSE, which is the Bachelor of Science, something like that, um called the BSE. So it's just easy to remember the BSE, which is the breaker cholic. Um You have the left common current as well as the left Subclavian BSE. All right. So moving on. So from if we're looking on, on the right or on the left, what is really important to us is that at the end of the day, it one of the branch of the Subclavian, all right is um um one of the, one of the brands of um the um oh of the um a um of the subclavian is the axillary. All right. And looking at this particular structure here, we can see that the um subclavian, all right is what would turn out to become the auxiliary based on its position. And then we've got the first part, the second part and third part of the subclavian, all right. Um And quite very important for us to remember and that's all in relation to the um clavicle. Um And so we've got, and that's where the word has come from the subclavian. So we've got the subclavian artery um which is basically um medial um to the anterior scaling. It's on the medial border of the anterior scaling. I've got the second part which is basically posterior um to the anterior scaling. And we've got the lateral part which is also um which is lateral, um finally, basically lateral border of the anterior scaling um as well as lateral border of the first r. Now, the important part of all the things you get tested on the, when I practice for the exam is in terms of the arti artery and the various parts of the axillary artery, which you got the three parts of the axillary artery also being determined based on a relationship to the m, right? So in the first part, we got the one. So you've got 123 and in the first part, you've got one branch. In the second part, you've got two branches and the third part, you've got three branches. All right. Um Which is, which is quite, in my own opinion. I think it's quite easy to remember. Just remember that you've got one in the first part. In the first part, you have one branch. In the second part, you have two branches. And the third part, you've got three branches. And I think it's, it's good information to have um and a good information to remember because these things get tested in the exam. Um I think one of the ways you can remember it, there is a code called screw the lawyer. Save a patient. Screw the lawyer, save a patient. All right. So when we say, screw the lawyer, the s of the screw represent the superior thoracic. All right. Screw D. So the D there, the TS, the thoraco dorsal artery and then the L which is the lawyer, screw the lawyer, lawyer. There represent the lateral thoracic. And we've got save the s there represent the subscapular artery. And then we've got e the A there represent the anterior saral artery and then we've got the p patient there representing the posterior sar complex humeral artery that could help you remember. Screw the lawyer, save a patient. All right. Moving on again. This is the various part of the um axillary artery. Very good to remember that. I think the middle part I guess tested is these branches or part of the axillary artery. Um just to quickly run through things. Um One of notes, remember the, we call the deep palmar arch as well as the palmer arch. Um It's quite very important to remember that. Um And not just to remember that all it's to um I used to remember that um these things like I said, are not particularly being tested in the exam. Um When it comes to the blood supply, um oiling blood supply is not heavily tested. Some of the venous drainage is quite very simple. You've got the superficial, which is the basal and the cephalic veins which represent superficial um venous drainage over the hand. Um Remember that a cephalic basically runs on the lateral side. Why the basilic runs essentially on the medial side. Remember that they are both connected at the cubital fossa by the median CC style vein. And those basic information to remember as far as that's concerned. So let's talk about the dima to of the upper limb. This is also very important to remember in terms of the um questions that you can expect in the in, in the exam. Essentially, you will need to cram this, you need to cram the myotome, you will need to cram the dermatome. This is quite important going for the exam. You can, one of the things I did was to print it out, place it on my wall. And I don't by seeing it constantly over time, that information just stopped to my head and I was able to remember. All right, you can just remember that the thumb is C six, the middle, the sorry, the index finger, the middle finger as well as the ring finger is C seven and the little finger is C eight. So remember C six for the thumb, C eight for the little finger. And every other thing in everything in the middle is C seven. So CC six for the thumb, C eight for the little finger and the three fingers in the middle is C seven. That's probably the best I can do in terms of giving you something to how and how to remember. All right, in terms of the Myotome, you also need to remember this, these things. Um It's also very important um to remember them. All right. Moving on just to look at some of the random questions. And we are, we are ending now just random questions that you probably find in the exam. So your questions, questions is asking the patients presents to clinic following a surgical procedure. She complains that she's unable to shrug her shoulder. What is the mo most likely under nine nerves? So you're seeing that these things are getting tested. Um This is a long term nerve, it is the arti nerve, right? It is a long thoracic nerve, um which I which applies the crotos anterior. Now, you will find all of these questions. Usually the following nerve supplies the majority of the skin on the palmar aspect of the thumb. But again, you will find these questions, um which we've talked about earlier and this is why these things are quite important for you to remember. All right, you'll find another question. Yes, you turn you open and go to the emergency department from a fall on examination. There is deformity and swelling in the forearm. The ability to flex the fingers or the affected limb is impaired. However, there is no sensory impairment. Imaging confirms it displays the forehand fracture, which of the nerves listed below is most likely affected. All right. Again, ability to flex the finger is affected with sensory supply is maintained, what is going on. So the flexors, what are, what supply the flexors? And like as I said earlier, if you can remember that the anterior and dire nerve essentially is myo is, is, is a mor nerve. So basically supplies muscles, right? Um And so it is the the anterior is the anterior nerve that a that supplies the flexors of the finger. And so that's the nerve being affected. So, it's very important to remember these things that these things get tested. Like we said earlier. Again, this is a question of talking about clon cases. This is why you need to remember clon ca and the things that are following CLM ca um the cause of breakup Plax are most commonly. What vessel II told you guys earlier, this thing gets tested as the axillary artery. Um which of the which of the nerves listed below is directly responsible for innovation of the lateral flexor. Again, we talked about this, the lateral aspect and this is what I told you earlier. Look at them asking about the median nerve, asking about the anterior inter nerve, even though the anterior inter nerve is a branch of the median nerve, both of them are now present. So it's important for you to know the specific those three muscles that the anterior nerve um supplies. And as I said earlier, besides the perinal terrace PT, which is supplied by purely by the median nerve. All right, as well as the ri long, um all all of the other structures in terms of the deep heart muscles of the forearm, of the anterior part of the forearm are supplied by the anterior, the os. So the answer here is the anterior inter, all right. Um which muscle is responsible for causing infection at the D I PJ. Um One of the things what you have mentioned, which we talked about last week is we talk about, you know, um uh the FDP and the F DS, right? Um We talk about the FDP causing that flexion at the D I PJ. Why the F DS is at the P I PJ? Right? These are simple questions you get asked. Um This is another question again, also testing a rugby player hit the shoulder had, you know, and clinically the hand is loose on the side and it's pronated, immediately rotated. What structure is affected. Now, this is why it's important to understand not just the specific nerves, but also the beer part of the breaker plexus because that's what's being tested here. Now, what's been tested here is not just one nerve is a a couple of nerves. So you need to understand the trunks and this is why this was quite, very important. So you're just see, basically these questions is just highlight some of the things that are quite very important for us to understand as far as the innovation is of, of your party is concerned because it is a middle aspect that is being tested in the exam. And just for time's sake, we we you can go back and check these things and you can watch the video later um on the platform and you can pause and um one of the things we'll do after the entire series is to try and share the slides with you guys and some of the people that joined last week I was gonna share the slides with them, but I didn't because I figure it's gonna be best to share the slides once we are done and you can have a single slide that contains all the information rather than sending in slight in bits. Um All right. So very good loads of questions, get tested, loads of questions, gets tested, loads of questions, gets tested and you can see questions, questions and questions. All right. So, um again, a very big thank you to everyone who has joined in um today. Um We've come to the end of today's conversation and next we'll be going on to the lower limb and that's not gonna be today. Uh um We would also again send out invitation um for us when we are gonna take the lower limb um anatomy and it would be nice if um you guys are able to join again, um as we talk about um lower limb anatomy, um essentially, um I would want everyone to please um complete uh I think I'm getting a question. All right. So I want everyone to please complete the um sheet if um everyone can complete the back. Oh, really? Really? It'd be helpful. Uh Once you completely get the um certificate about you look this in as you that. Yes, you've, you've Yeah. Um Howled your CBD. Right. Right. So bye F on the um F is it more at 10? Um Thank you very much. Yeah, everyone Goodbye.