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Yeah, Yeah. Looks like there's still a couple of people joining, so we'll just give it another couple of minutes, because those point, it's fun. Okay. Okay. Yeah, I think pretty make us start now. So welcome, everybody to the end of serious quiz for the upper limbs. Siris, um, run by bombs in London of the essential pedic electricity's. My name's James. I'm on a junior doctor working in the Oxford dinner. At the moment on Sharon, some bony is, uh, orthopedic. Red stripe is gonna be giving a talk today. A little quiz today. Um, so the end of the session will put a link well part with you to set it off. A link for feedback in the chat eso if you could try and fill that out straightaway after the recession's finished. Because I will already be closing that link quite soon afterwards because we've had some people filling in feedback even though they haven't attended the lecture. So if you could fill that out straight away so you could get your stiffness on, we'll probably close that after half an hour or now, um, so that no one else can like, um, we're going to see how we're going to try using a Google pole today for the quiz, but we're not sure how that's how well that would go otherwise, you might have to resort to just put in your answers in the chat, but we'll see how things go. So without any further, do a hand over to Sharon who will take it from here. Thank you, James. Food That introduction So grieving guys, My name is Ms Someone in one of the very strong as working in the East billions suppression of being a hearing a bomb said too have run this session so special Thanks a bomb. So if I if I be over and having me to run this session I thought was tribal of a quick tests to make sure that the Dutoprol was working Before you go any any head So if you can ask us to vote on harmony fingers Do you think there are in the hand my skin Easy answer How many fingers are there in the hand? There is only one answer If you haven't trouble voting Please Please Mr the chat If they should be a doodle pulling right link in there Today's session is very interactive. Guys, we do need your participation. James. You wanna double check? The link is working on your side. Doesn't make sure that that's not a cliche. Yeah, I'm just having a look, uh, to see if I can submit an answer as well. Okay. So clearly says we're okay. Which is really good to hear. Yeah, Looks like it's working. I got to answer so far Semesters. James and Candy. Yeah. Um, so I really do need you guys t o t employees. Just so we just need to be interactive for a reason. Okay, Announce coming in now. Okay. Night. All right. Okay. We'll pull. It wasn't there. So things got three ounces for C. I have to tell you guys, they're actually only four fingers in the hand and one of the thumb eso the answer. Whoever answered. See, Papa didn't get quite the mark on that one. Strictly speaking, I understand that we talk about five failing says, but the actual fingers in the main culture starting four fingers in the in hand. One fabulous. Okay, so we will start the next session. So we say which of the following is elbow burn Which of the following is the actual Elavil bone? Is it the electrodes on process, the lateral epicondyle or the radial tuberosity? I'm not sure if you're struggling to get to goal is to do a pool it. Otherwise, you can put your answers in the cecum more than happy to have an instant shot. And that's me towards you guys. Which of the following is the actual albumin not getting any answers? Coming in, actually. Okay. Currently noted. Thank you for that. Anybody else was that want to hear? How did I guess? You know, I do have your names on here. I could start picking people. Yeah, okay. Omar Omar's is child timing in it. That's fine, guys. If you just use a chat rather than do the bought, I'm happy with that button issue. So the answer is a A. So it is a liquid on process. Lateral epicondyle actually is about the humerus and the realtor. Brasi in itself is just part anatomical part off the proper radius. The actual actual part of the elbow, one of the bones that comprises the elbows, actually a liquid on on collision. There's a liquid on process. So the answer is definitely a, uh Okay. Nice and easy one. The head of the radius articulates with what capital? Um, the trochlear of the glenoid cavity. What does the head of the radius articulate with? Tell her. I mean, there's more than two people on Cole. So anybody else was to chime in, give you guys in their 45 seconds, got to a Z and a B. So far, Caffeine, uh, zoom may Alec. Don't be shy, guys. Is is an eye on it, You know, romances. It's very safe spaces to come in and get your your knowledge to see what you know gets harder. But this is nice and easy for now. Okay, so, uh, let's go through the answer. So the radio head actually articulates with the capital. The radial head is a very shallow, calm cave joint burn. Sorry on do it allows rotation. So the capital, um, which is a smooth, rounded structure, allows a redhead to take around it as well as flex. Okay, last notation so sufficient pronation as well as flexion extension the trochlea itself. Although it is part of this whole humerus actually articulate with the coronoid okay and have a corner for PSA on the liquid and forces trochlea. Is that older? Bit broken on a bit. Okay. Annoyed is within the shoulders. A complete far from the elbow. So are the three answers that the car answers to capitellum. Well done. Who granted? Eight. Which of the following is the lateral bone off the antibiotic in which of the following It's lateral bone off the anti break. Um, is that the only other radio on the humerus? James and said anyway, else once one was positive. Guess Alec Coffee. So the most lateral blood of the anti breakage of the anti brick it was actually the can take your forces a great deal of my hand and she break in. Okay, break here tends to mean for, um Okay, so brachioradialis is the muscle of the forearm break. It is the forearm, and it's approximately aspect of the forearm, so the lateral bone is in fact, the radius. Okay, we have the only immediately or only immediately on. Well, actually, we have the radius, the humerus part of the arm on together. All three burns comprised the elbow. Okay, So, looking at osteology become answers of radius, so Well done, James. And home on the trapezoid of the wrist. The trap is the weight off the wrist is blank to the capitate traps of the wrist is blanked The capital Lateral medial superior radio. Oh, my. You could get to get the PICC one. Is it B or A? You put two times down there. No, be was beyond Still are special. I think a things lateral to the capital. Don't think. Okay, so this is a trick question, guys. Okay, so, strictly speaking on atomic is speaking is lateral to the capitate. Okay, But when we talk about it clinically, which we'll talk about things being radio or older because it's hard to, you know, if I put my hand like this, what's lateral? What's medial is very less clear compared to that, this will say, Well, that's lateral or that lateral. That's medial. And you get confused so strict you speak to make it absolutely clear we'll talk about things being radio or owner. Okay, so I told me he's big could say it's a natural, but actually the cover after here was radio radio because the the rate is is always in line with the thumb in respect of whether it's prudent supinated Okay. And we know that the trapezium exists underneath the thumb and the thumb just next to that slave owner to the trapezius on is a trap, reside. And then, although to that is the capital, which means that the trapezium is radio to do the capitate. Okay, so different America chur. But, um but you have radios a correct answer by Understand what you guys said eight, You're not wrong, but the current most appropriate and said would be radio. Okay, How many failings is how many feelings is comprised the Publix? Because the thumb Okay, thumb harmony Felixes exist. So very quick responses there. Nice and easy Question it seems Okay, So those lines of bees absolute correct. If the original finger has three fillings, is props the middle and distal Okay, in the thumb, the only hard to feelings is approximately distant. Okay, The thumb itself is a shorter digit compared to Europe. Finger All right. And it requires it's more for gripping function rather than the finger which has a much longer reach. Okay, that's why the thumb itself is supposed was very long. It would be very hard for to propose. Have a good grip. Strength. The only two fillings is with, um Okay, how many car pulled bones exist in the rest? How many car pulled bones exist in the wrist started and get bit more challenging. Now, couple more minutes. Look second rather minutes. Anybody else was answer. Okay, The answer is see, Absolutely. They are eight Coppell bones in the wrist. Okay, for the proximal worry, that's for in the distal over. Okay, we'll talk about those and minutes. A song Which of the following is not in the distal carpal right? Which of the following bones can you not find in the distal carpal? Over We said there's four in the proximal and for the distal and they're five options there which other for one could not find just a couple, right? Keep people faint. More seconds. This question. Always get people cases. Carpal bones, people think is very easy. But it's not. It's once you get in your mind, you have often there was a pneumonic for it's using Monix the use different words in America Tresiba But once you get in your mind, it's very easy. Okay, um but it's very common example. Esch in this is very important to know the couple bones. Okay, so the answer actually is a visible that Omar the answers A right. So And that this little room starting from radio two. Owner. I do that deliberately because my thumb is radio. Okay. Radial two owner candy. We talked about that. The TRAPEZIUM is gonna meet the thumb. So em for thumb. Okay, that's why that's what the answer is not see. Next strip easy. Um, is the truck is a weight. The capitate and one of the half a minute. Okay, that if you go to go to the proximal worry, we have the skate point. The try quit. Did the lunate triquetrum on the pets? A form? Which is we? No, no. The pill is a form is what kind of burning? Absolutely. Jane James and nickel thing is nickel after nickel. Correct. Correct answer. It's a says my bone, and that means it exists with an attendant. Okay, you'd be familiar that the patella is all just had my bone because exist within the tendon of excess. Make it isn't the course of the patella tendon. The Pisit form exists with an attending off fast. Copy, old Maris. Because they just have my daughter. Okay, well done. Yeah, Nickel. The owner of lies. Something to the owner artery. Is it lying? Major? Natural, superior to still or inferior to the ulnar artery. Sliding will calm, more complex question. Okay, slight. More technical. 10 more seconds, guys. Okay, let's go through the answer. So, strictly speaking, the older nerve like Medio or more owner to the owner artery. Okay? Lives medio to the on the artery. You could find the elderly over here, within beyond canal as it enters the wrist. Okay, lies more Medio to deal in your artery. This is important because you cut over here. You need to know where we are with nervous blows. Equally he become compressed the rest. Okay, this is very important to know that piece of anatomy how many tendons exist in the carpal tunnel? Okay, the answer is see, So there's 4 10 minutes off the FDs actually shows callous on before the profundis theater deal does go through the carpal tunnel. Slightly more radio. Okay, but, uh and it depends on what kind of text you you pick up and read. But most text, particularly old attacks. We'll talk about there being traditionally eight tendons. Remember, the FDA has anti pressure common belly within the forearm, but that the tendons as they come in this up divide and supply each of the four digits. And as it goes, the carpal tunnel, you would find that on, they divide and come together and pull a less to give the give the relevant attachments. Okay, the median nerve does not divide before the carpal tunnel. Is that true faults, or are there variations? Anybody else? Okay, so the answer is full. The meeting does divide proximal to that, uh, transverse carpal ligament. Get the effects of reconnect about five cm, most proximal to that. It gives off a branch which goes over the first one second, um, and forms a public things branch. Okay, it is very important to me examining the hand examine from median nerve pathology because so the meaning of proper goes to the carpal tunnel where device again to give the recurrent water branch and then the remaining distal nerves. The Raiders of the hunt. But fox melted the Axiron back in him. Give him a further branch which goes over the retinaculum to give absolutely supply sensation to the palm. Okay, the answer is force. The best test to diagnose carpal tunnel syndrome is what is the best clinical test to diagnose carpal tunnel syndrome. 10 more seconds. Okay, so burgers test is actually spelled wrong her deliberately but burgers test spell be you eat is the test is used in vascular of examinations. Look for vascular sufficiency onto this efficiency, uh, on on the different ways of doing it. Okay. Palace doesn't really exist, Not the money. Where of governors is often used more and shoulders. 10 of tests is where you tap over any nerve. So if I could do 10 hours of the older nerve test of the median nerve centres tapping on the nerve which aggravates that nerve and causes a sensation of paresthesia or tingling. Okay. Phalen's test is simulating compression off that median. Nerve the wrist. Okay, there's reverse Phalen's and normal feelings with the prayer sign. Reverse Phalen's. But it has a much higher sensitivity to diagnose potential carpet on a syndrome competitive test. The answer of a Any question about that study found. That's what an important question to know. Okay, Good the first line treatment off carpal tunnel syndrome is the first line treatment for carpal tunnel syndrome is 20 more seconds. Okay, so the first line trip of carpal tunnel syndrome is actually a general speaking. We we ask patients to rest on. We give them a temporary splint. The most common complaints from patients is nighttime pain, which what's worse in the morning, often because there, by the late on their hand, risk being very much flex on. We do know that the median nerve goes to the festival tenaculum and is most vulnerable when it's flexed. Okay, so the first line treatment is given a splint to reduce deflection off that wrist. Okay, on it's temporary splint, we can offer patients several injections, and this is made it to reduce the inflammation around the meeting very successful and most times patients getting continued symptoms for about a year or so with with positive of condition studies. They then require some form of a cop. It'll decompression now. The most common perform way of doing that is open car put on the compression surgery, so a small cut on the rest over here various very small cut, reduced of attack. Let me open it up. And just for the nerve, there was a normal idea of doing it off the carpet leads, Um, very small, small stab wound and going with this little scope, but it hasn't really taken, taken up very much within the orthopedic world. So generally speaking, first line we try and rest a splint that doesn't work. Most of the patients then get often an open carpet on the compression. Those patients who don't have surgery either because I'm not fit for surgery, which is not very often or those who are keen on it. I want to try a star infection first and again. The cavity is a minute work, and they may struggle to head operation in the future. Is that okay? Anybody take how many extent of compartments exists in the wrist, how many extent of compartments exists in the list? It's a test of you guys are not to me. This is again a slightly more difficult question. Um, I wouldn't blame you guys. Get it in the hands to this side. More difficult question in case the Antichrist see, there are six dorsal compartment and six was put in the wrist Onda. The tendons off the extensive compartment come in. They get the lying one of these six compartments endorsement, arrest as it passed through here. But then supply the relevant digits or actually going to do okay, we actually are. Six distinct compartment within the wrist on this is most common. Most important to know, considering said it arrest equally when considering certain fractures. For example, distal radius fractures in which some attendance are more vulnerable because where they lie in relationships compartments. Okay, they're six compartments of the wrist with the excessive compartment. Okay, Pulled elbow is most common. Between what age range. What is the most common? A dream to have a pool. Okay, Any of any other people answering questions or, you know, teachers. I've got two so far, they call Kelly. Okay, so the answer's a The most common age range is between 1 to 4. H group is when the the ligament full, Um uh is no as well developed. And we'll talk about that in the next light. But most commonly see it within this younger age group. Okay, Pulled elbow effects. Which ligament? A. Which structure? Yeah. The answer is the annual exam into to see you around ligament or a semi circle ligament. Okay, that holds the radial head. Okay, within, within the joint. So I can rotate Nice to super important nicely. Okay, so in in a younger age group is ligament is a very strong on. When the child was traditionally being swung, the traditional methods injury is a child would be held on both arms, fully extended, being swung. The the red hair was underdeveloped on ligament, which is not very tight. Can heck investigate. I was, uh, blocks from that ligament on my artistically completely. Corporations was off the PSA blocks on this condition, reduced very quickly on that provides often good stability wants to be reduced. Okay, So the and ligament is what gets impacted most with this kind of injury. So a 21 year old student, much like may have yourselves present with elbow swelling over seven days with some erythema. The most likely diagnosis is what 21 year old seven days history of everything that's willing. What is the most likely diagnosis? Is anybody else? Any other thinkers? Clinical? I understand that anybody else the court and just beat election on both scientists. So septic arthritis of the elbow is not very common can happen. Not really common. Okay, it's blinking. Not very common in somebody. Who is that? Young and 21 year olds. Okay, within the elbow there. Different birth. That one. The most common versus, which could be irritated. Called the liquid and bursa. And often students who lying on their elbows while studying Or, you know, the table can irritate that bursa into a chronic, insidious swelling with the middle of the time and a rhythm. A Okay, septic off first can happen. Um, often is, um, risk factors for this, Um, so again, very common on, you know, it could be trauma. But in this case, too, was trauma expected to be very quick swelling and more acute history than a 70 ongoing history was Marathi my? Okay, So the current answer is most likely a liquid on both scientists, Commonly managed with antibiotics, anti inflammatories, nice and elevation. We don't try and often in size liquid on both sides. Just unless we think it's infected on the forms and abscess. And in this case, we're forced cause of patients septic, and they're forced to have an operation Majority time these patients settled down. The treatment is often imagine of symptoms, which is often inflammation and pain, etcetera, repetitive, straining off the extensive order and tendon is best known as very quick answers coming through here. Okay, the answer is. Detain this elbow. It's also called lateral epicondyle itis, So the extensor origin attached to the lateral epicondyle repetitive strain. When the tennis traditional tennis I could be any, any sport causes repetitive extension strain and that pose on the lateral epicondyle, causing irritation of the insertional point lead into tennis. Elbow off the match conservatively with rest ice for the therapy. Sometimes compression brace is to help reduce that ongoing straining off that organ sites. Okay, conversely, medial epicondylitis, where the flecks of origin is affected, is commonly known as golfers elbow where you get the same mechanism. But rather than being an extensive injury is repetitive hyperflexion or aggressive flexion, much like when you're doing a golf shot, the older nerve passes through which space the only nerve pastor which case? Okay, the answer is, See the Cuban tunnel. So the carpal tunnel is we discussed already in the wrist. The meaner goes through okay, very where the comes through. The winter comes down from the medial quarter. Brickell plexus travels down that the arm on goes behind the elbow where it passes through the through the tunnel. Okay, is important because any inflammation at this area can cause Cubital syndrome, which leaves the paresthesia of the only nerve, sometimes causing all the nerve palsy. Okay, and the kind of patient we could do. A simple operation. We can decompressed tunnel, therefore freeing up the other nerve. Right? So it's important to know. Equally speaking, you can do to help the test of the cable tunnel. So it's still still tapping test like they do for them, you know, to test and embarrass their symptoms. You may get it. Okay, so, you know, we talked about the funny bone have ever heard about the funny bone where the on the nerve is vulnerable at the elbow. That's basically internal tests. Your stomach tapped me on the nerve of the elbow into no test to try and test the Paris easy effect. I think the radial nerve in the arm fast is the radial nerve in the arm facets. You guys are just not going away from the wrist and more towards the elbow and arm plate. The current answer is, is be at some point, it does pass lateral to the humerus mawr that just will hear herself whether the arm itself, the majority time it comes from the posterior according to break the plexus on travels in the spot A groove. Okay, Where? Where? Eventually they put a couple left humerus. Okay, so that spiral group is very important or discussed. Why? Shortly the lateral border off the anti cubital force. It is what muscle comprised lateral border off the anti cubital fossa. So 20 seconds, guys. The co Kelly. Okay, the current answer is be was brachioradialis James, who's the answer correctly can tell me that one of the borders off the antecubital fossa. Um, your breast. Um it was just about the lateral board. I'm not really too sure about the others. That's probably what What is it? The biceps tendon. The medial, maybe. Okay, Nicole, do you know the boards? The off the anticonvulsant, the in the media board is the prorated terrorist. You disappear. Really? Issue of medial epicondyle. Oh, so no question to the lab for boys Break. You're really on this In case the medial border is pretty terrorists on the superior border. Actually, it trans epicondyle line is just drawn between both epicondyle is not, strictly speaking. Want that kind of the other? We drawing. Imagine relying too. This week between both epicondyle on the forms triangle. I was trying okay in the knee, for example. In the property, of course, it's a diamond shape. But however, in the attic or before, so it's it. It did a triangle. So you have. The big reality is laterally. Pressure is immediately and in the superior e will prop disappear. Really will have the random imagine line between both of the Cornell. Take again, guys. Very important. Common exam question. Very important. Know this. It's it's It's literally a favorite amongst many times. What is the floor off the antecubital four, sir, What comprises the floor off the anti cubital fossa. Okay, the answers. Actually, a is breaking, breaking Alice. Okay, So super NATO and and Korea's are slightly more lateral. In some antifungal books, you consistently forms part of the floor laterally. But the majority of flora actually found a form by breaking Alice. Okay, which is a very powerful Flexer off the elbow. Um, so it's important to know your space is particularly in the on on day four on on a legs is a very common some favorites. Uh, we have the floor is actually break your list, which is important to be access to shoulder from the anterior side to the elephant anterior side on. Go down way can have to reflect that the brachialis see the elbow joint itself. Okay, more naturally, we're going. Sometimes we'll see supinated of gather supinated the arm at the forearm. Tears out of the way. That's what. That's okay. Roughly half the guys were making good progress. Well, then it's a far what is the most medial structure in the antecubital fossa. What is the most medial structure in the antique it before? So Hey, Kelly. Omar. Nicole. Anybody else who's joining in 10 more seconds. Okay, so the answer is D. The median nerves, all markers. You have the question correctly. You tell me from the media. Little, actually, one of the structures you find in the antecubital fossa. Um, so you have the median nerve, and then is it the break your pain in the break a lottery. Is there a regular? Is it a break? A vein? You know the city. Great. So there's there's a Catholic been a basilic vein, but there's no break. Your vein. Okay? Record is a bigger cuff, Alec Vein. That's not quite the same. Okay, on which again don't really exist at that at that level. But you're right. So it's the median nerve. The brick artery. Then there's a good lunch meds, and then the radio. There's a lot. Sorry. Is it the radio nerve laterally? Yeah. And what was in between that I did? I Okay, so there's actually four structures within that ticket. A force. Okay, so you go from me. Total lateral media nerve break. Large re biceps tendon. Okay, on, then, radio nerves way. We want to look at your elbow itself on partially flex your your elbow. Okay. We'll put your fingers in here. You can just feel your bicep's tendon to be a solid structure if you can't feel it. Yeah, you're not worrying me. Okay. Put sugar with a free little bit about figure, actually. Unleash it. Okay, so that's roughly half way between the median nerve and the radial nerve just medial to that. You know the field, You break your pulse. Think a few few perfect palpate well enough. So often the vessel finding that is, once you found it by some tendon, go to like the middle toe, which extend your arm on the brick. Your large becomes more superficial and you will feel that pulse posted. Anyway, your mind later is the indication of medial collateral. They're what? What exists, James? The owner actually is on the medial side, but it's actually posterior to the middle of a condo. It's not strictly the anti cubital. Foster is actually in proxies posterior to the media Pecan. Now where it goes through the people tunnel underneath, and then it comes up into the forearm. Okay. Flex opposes Longest can be found in the All right. Can you find fbo? Okay, Kelly Or more? Nicole. Okay. Okay. All right. The answers. We Okay, So that's the reason why I included is questions. Very important. So you it's very important to read every single word off the answer. Okay. Um, so I examined quite lost medical students. I write questions with exams as well. Has examined your skis as well. So words make a difference. Okay, so let's look at the options. So we all know that it shouldn't be in the flex. A component first compartment off the four on cake. The question is, is it's official, or is it deep? Onda? Um fbl? Because it's a deep muscle. It's found in the deeper compartment off the forearm. Where does the the flecks of the interferon and your joint? Because the longest tendon comes, in fact, that the interval is your joint. Okay, the wrist D, which is as deep a couple of the arm be arm itself doesn't have any fascicle compartment in it. Okay, so that's strictly speaking, not correct. So it's important to read the answers off. Uh, each word carefully. Okay, the media nerve is located. Where is the median nerve located? So we know it is noticed. Medio antecubital fossa. Well, let's go up to that. I thought I just did states today and I discussed from a case or somebody had cut the median nerve we had to repair. It was quite quite right of anatomy to know where that is. Ticker's. Where is the meeting of located? Okay, the enters, See? It's it after it passes anterior to the middle of the condo, it crosses, goes through the two heads off. Planetary is okay. As it does this, it dives deeper to F. D s. Between Fcr FC be could be found. It travels across the floor on the forearm where it divides into the palm of containers nerve. And then the meeting of proper go to the competent. All. Okay, so in the forearm itself, we found deep to FDs. Okay. With me so far. Hoping say good. How many muscles comprised the rotator cuff? How many's muscles comprised of rotator cuff. Okay, Stefan. And what are they? What? The answer is eight. What are the more the muscles that comprise of rotator cuff? Oh, our James. What were the muscles that comprise? Ready to cough? Um, I can't remember all of them, um, as the like. Subscapularis as a super spine. A tous. Um, I'm not calling the other two. Okay, So subscapularis super spine a tous in first Finate is and terrorist minor four muscles and they form a cuff around the around the shoulder joint to help stabilize the shoulder. Okay. The supraspinatus is attached to the lesser tremor. Ossetia. True folks or there are there antimalarial to supraspinatus is attached less a trip. A rosset e True False are the variations. Kenley. James. Cool. Okay, Nicole. Your crops to correct. So what muscle is attached to the Estradiol city? Absolutely correct. So there's four muscles, three of them attached. The greater porosity only subcapital are is is attached Lester bras to be okay. And that is why it's responsible for internal rotation. So the humerus joints a ball of socket joint. Okay. Lester Rosty, as a self tapers pulls it because internal rotation, it pulls like this. Okay, super smart it is. Does abduction initially and then it's been is and terrorist minor charges. Slightly more meat slightly mawr immediately causes external rotation. Okay, fracture the shaft of the humerus. Most commonly damage is what nerve faxed the shop for humorous. Most common damage is what no home. Okay, see answers. See, the red nerve discussed Iran that the rating of goes in the spinal group of the shaft. So any shaft fracture most commonly causes a damage to the radio nerve called the patient have a wrist drop because the extensors are compromised off the forearm and the patient unable to extend the wrist. Okay, so the wrist drop because unopposed action off the flex is okay. Um, typically, answer is See, the exhilarate nerve comes from which cord off the brace of break up Lexus to the regular flex is very important at me. Didn't know that. Um, another exam favorite. What's cord does the axilla you know have come from? We got a three way split here between a B and C A type breakers. Omar Kelly. Anybody else who's getting audience Want to break the tie? No. Okay, the anterior. See the posterior record. Okay. So I wouldn't go through all that. I have a break for the next with you with this. It's very extensive, but the media move comes off the lateral court, actually off both because they both come together to form that. The media know if the medial Corgan's rusty only live primarily on the posterior cord, gives rise, the radio and axillary know primarily. Then obviously the other never come across before then. Okay, so it's very important to know your nerves. What cords and roots and start the conference because the exam paper it the gas to draw it. Sometimes it's a Muskie's they can ask you to on is a very common STD question. Um, so definitely worth doing the deltoid muscle is innovated by which nerve the deltoid muscle is innovated by which no, okay, theanti a is the exhilarate nerve. It also supplies terrorist minor as well. So it is a very important nerve. Um, calmly who come in who? And the last question as good. We never talked about Shaft, so it's on lead damage in a proximal humerus fracture. So around the surgical neck where the nerve wraps around the humerus, that's where is most vulnerable. Okay, um, battery Delta muscle largely is. So you need any damage to the axillary nerves cause loss of sensation off the deltoid muscle. I'm on the skin that is a resident of regimental bad area. People who are military would know. That's where you have a badge over here on uniforms, but also the deltoid muscle get elevated, so you lose the actual deltoid. Okay. Its function is primarily abduction between 30 to 90 degrees as well as some flexion and extension of the shoulders is very important. Muscle for the shoulder on so examiner policies is, it's a big problem. Okay, The shoulders. What kind of joint? What kind of joint is a shoulder? Is it stable or stable? Partially stable. Six. Very. Okay. So, strictly speaking, the shoulder joint is a very unstable joint. Okay, It's very shallow. Bolus socket joint shall annoyed. Okay, There are some factor static. And then, in fact, it helps stabilize and join their muscles and get a cuff. There is the capsule. There's a labrum, all the different things that helps stabilize that joint. But it's unstable because it's a very shallow joint. I ask people of large groups of movement in much how much your shoulder could do if you ever seen those people who can, you know, desiccates the shoulder and do all kind of different things. And it was kind of in circus stuff. It's a very careful of hyper diffuse movement, okay, and because of that, it's largely stable. So it's a joint we take seriously when it comes to this occasions, Um, Andi. Often you find patients who have lax ligaments or or lack scrapped issues disorders. They tend to have recovered journalistic Asians. So on that note, the shoulder joint most common desiccates in what direction? Yeah. Okay. All right. The answer is D and, um, fear. Really? So the most common it is for a tickle posteriorly. It has to go beyond the strong chromium, which is which is behind it. Um, so the most common direction which it goes is anteriorly often onto inferior because the the tendon off major pulls it until really an inferior lee. Okay. So often you find patients. They the the commercialization, anterior. Really? That was supporting their elbow to bring the humor's up on the try and counteract the muscles, too. Strong muscles off the the anterior chest wall. Okay, um, it is important on is a very common injured. The shoulder particular among young athletes. Uh, s O. As it's important to recognize this, the chance off read every dislocation, post shoulder dislocation in the elderly Patient is what I served that says a B C D. Okay, so the answer is, But yet it's very high is because as you get older, the structures that help support as theory shoulder gets more degenerative, so we'll get a cuff. Become what? Degenerative? The muscle come weaker, more lax. All these factors to help provide stability, especially after one reason. One desiccation. Where is a really ripped apart, too damaged chances of it just getting asthma pyre. Okay, on So often these patients may have some kind of procedure and help stabilize this these joints. Okay, The really logical finding in a posterior dislocation is called What? Okay. The actors beat the light bulb sign. Okay, Um, when it desiccates posteriorly the shoulder Internet rotates and so imagine that's the shoulder. Never bought a little bulb here as it desiccating terrible teeth. You seem or around a structure on. If you think back to a light bulb has rounded structure on next three, you're taking the red. A graph of it. It looks like a light bulb. Okay, So called light bulb sign. Okay. Very important to diagnose prostate. It's occasions are very limiting. It's very bad news, actually. Participation daughter on much more problematic that after desiccation. So that area is very important. Okay. Often they every sometimes require production the interest riled and down and 80 for example. So any recreation really helps to that process. How many stages are there to adhesive capsulitis? How many stages are there? Two t's it capsulitis Okay, the answers. Eight. There's three. So it's alternatives. Frozen shoulder. Okay, there's three main stages. There is the free, the kind of the freezing, the frozen in the throwing stage. Okay, so freezing is when you get, um, Mork kind of pain compared to stiffness at the frozen stage. It's more stiff, rather painful cause, or the frozen okay on their throwing stages where they think is going to get better. Okay, on the stiffness gradually improves. Sometimes they require multiple. It's under anesthetic to help reduce the adhesions. So and he said, capsulitis patients form reducing them movement very common in diabetics. So in these patients, often the other have a procedure done to have reduced those adhesions or the how many pressure and, I said, help break couple occasions to get them moving and tight. A Kruma critical joint pain can be elicited by which clinical tests so she could hear split over here. Amongst most, the answer is the anti a scarf test. Okay, is when you can use your opposite hand. So that's it. That's it. My, um, my right side. I mean pain. So I would I would acid patient right on touch up that shoulder. This aggravates the zj job, right? Causing pain often helps. Like nose is your arthritis, but it's golf. Testes tend to use called Scott because you're happy and your next dose cough. Okay, jobs test is more for as disability. Auntie can't test us more for impingement. So you kind of really Taxes, cough test shoulder pain Judgment is most commonly due to which tender Sure, older pigment is most common. Do two. Which tendon? Okay, the an interest Super Spy natives, okay, is a tendon that goes that caused closest under the subacromially space. So impingement is caused by a sub acromial impingement and they need to sort of come a burst. The most common you find Super Spinous tendon. It's going to come calcified callus if it tendonitis or impinged. Um, and this causes This is the typical pain off shore and test you actually causing rotation. So internal rotation off the shore, that good anymore joint and to the human ahead, pressed against the super Spinous tendon on aggravates against so supportive Bursa. That's what get the most pain with the empty camp tests. Okay, That's why it's important test to do what degrees of movement most commonly occurring. I'm whether that there are variations of this. What are the most common reason? Movement. Okay, the answer is ah, weather, James. But the answer is D uh, 60 to 1 20. So let's think wise. I think the a closer it's just been it's tender on then. That's where this okay, And then as it gets to about 90 100 degrees, the shoulder starts rotating because the trapezius muscle on beyond kind of 1 20 shoulders more rotated capital, Not not more rotating on until then, the more head for free. So find that, is it Oh, okay. Oh, it's very, very, very painful. Uh, okay, I'm much, Much better now is because of humor has fallen out of place from the super specialist. And then no, I already right within that are called movement. It's most common that that tendon causing your invitation. Okay, that's the reason why that tends to occur during those decreasing movement on the nerve. Posey is more pronounced with what kind of lesion over there. Palsy is more pronounced with what kind of lesion. Another exam favorite is that tough question. That's a question, but it's a very important to know we were going to reply on diarrhea. Okay. Theanti is distal. Okay. Explaining why it's called the ulnar nerve paradox. Okay, the only have supplies. Couple of the four are muscles on the under medial side. Okay, on the supply is the muscle of the hand. Okay, So any illusion has more proximal so cute. I know anyone in the elbow. You up here? Okay, Carol eyes the muscles in the forearm as well as the hand muscles. Okay. All inner posey in the hand wrist just to make old cause cause stomach cold floor. And we get a clot finger. Okay. Now, in a lesion, that's more proximal because a paralyzed we try make a fist that clawing is less pronounced because the muscles are paralyzed. Things that the media half of FDP FC. You All these muscles are not supply innovated. You don't have any action. They don't put as was clawing. A lesion has more distal there. The rest, for example. These muscles are still preserved. So the FDP, for example, supply there. The the medial have visited the ring and the little finger can still pull on them, causing clawing. So a more distant lesion. It looks worse, but it's better for the patient, whereas a more proximal lesion looks better but is worse for the patient was problem nicest. Okay, it's called the ulnar nerve. Paradox is a very important question to know about another exam favorite. So that's how it's plain it it relates back. The muscle will be innovated on where that must be innovated approximately. It will lose everything in the forearm on hand. Distillate on the minute. The hand on the forearm muscles are really preserved. Okay, Encourage you guys have read upon. That is very important. I think this is the second last question almost there. Guys on the on the nerve in the risk of the comprise. Compressed against what? What again, what burn can the online of compress against? Yeah. Oh, okay. He's a career answer world. I'm going. I say, um, theology left and the rest times to Beyonce Canal, and it travels in between the hook off the hum. It's a very a cyclist. For example. I'm calling psyching injury where you're particularly if you do those road bikes where you have to lean for a lot impress against your hands if you don't have padding, for example, you can compress the nerve because look, a ham is very, very official. You felt on the on the side, Um, and you press over there, you compress the all the nerve, which again, as I said, supplies the majority of the hand muscles. And so you get you can get on the nerve we can get, Ah, wasting the high protein eminence. You can get weakness of the hand muscle from the interosseous eyes. So it's very important in cycling, Um, and important to recognize. Okay, so the current answer was eat. Last question. What are the bones in the wrist is highest risk of non union, which the bone of the risk is the highest risk of non union last question guys who every answer it. So we'll go silent the entire time. I like the Nicole, you know, start the questions. The last question. I have a long day. Okay, so the correct answer is deeds skateboards world in. And this is because it has a higher chance off a Baskin the crosis the blood supply. The skateboard is retrograde. So it goes from the distal Paul coming a retrograde to the proximal pool, any fracture on the waist or the more processed more bits off the skate. Boyd as a high chance of a vascular necrosis, also has a higher chance of nonunion. Okay, pardon me for for a bone to heal everywhere has good blood supply. So it doesn't get that breast supply. It cannot You okay? And that's why it's got the highest chance of noni and compared to the other four options now, after that, things are rare. Styloid rid of a headache and all sudden going on union. But the highest risk, actually, still blasts care for it. Okay, Depends of where the fracture happens on it matches back into it into the better by something. So, guys, that and this is today has been a now and a half roughly just started off. Our quest went through about 45. So questions with Scott cover quite a lot of the of the upper limit. Uh, I think today and obviously, you know, helping out there's a cure court there and lengthy back and really appreciate feedback has helps us determine how we continue our best. You guys, um and also that because it says it says it because as well, I'm I'm more than happy. Now take any questions. May anybody else and you know who needs, you know, upper limb teaching. So if you're not sure about something will cover already or today's questions feel free to ask me now I'm happy to talk about it, um, or any questions, you know, pretty sure off the body instead of going through on we'll have to address is now as well. I open up to the floor for any questions composed in the jack. They can post talk about the order on voice on more than happy. Thank you so much on that was really good. Um, yeah, we'll give you Give people a few minutes to ask questions if they want. Um, And if you could fill out feedback straight away, that be great movie really close the link after half an hour or so just to make sure that no one else comes in and tries to get a certificate for watching when they didn't actually watch it. So if you will fill that straight away on, don't stick around for a few minutes for any extra questions on the ah, the last things that is next week. Uh, there'll be a talk on Monday. Um, Onda try to remember which one that is now they'll be the start of the next Siris. Um, that'll be lower limb. Yeah, the lower limbs start low, and I'm serious. Will be all on for ankle. The another important topic for the NyQuil. Another common favorite on exams. So we're we're we're great guys. Um, thank you. Bomb suffer for Invites me to today's session. Um, I appreciate being here on, uh, yeah, I think things got to be in the low Starks that there was a change. Obviously. Bit of a change. With time, certain new went to go in, So but I think we got human people joining their on. So thanks everybody for for coming along. No worries, guys. I'm sitting there. No question. If any questions, dreams or in every emails or anything, let me know more than happy to answer via email. Whatever. Um, you know that's fine with me. Uh uh. But world and guys, whoever interactive and participated you guys did did Well, There was some challenging questions in there to test your knowledge. It's very important anatomy. Enough to live as we even loan him stuff. But that's been up a little bit more difficult. Bit lower limb so worth revised. Some of that took your shoulders and wrists on your body. Fine. All right. Doesn't look like there any questions. Yeah, Everybody feel free to a head off. Thank you very much. Again. Thank you. Appreciate it. That's kind of you guys have a good evening. You too. Thanks.