DIP Episode 305 - Upper Limb Rapid Review 1 (for the USMLE exams)

Okay, welcome. My name is Divine. This is episode 305 of the Divine Intervention podcasts. And in this podcast I'm going to be doing something I call like a very rapid review of Upper Limba Natham. Like literally this is actually one of these good, one of these good podcasts to make an Anki Decoff. If there's any one you want to make an Anki Decoff, this is one. The thing is for this podcast my primary goal is to focus on clinical contexts, right? So the thing is again it's a rapid review, right? So it's a rapid review. So that's my goal, right? That's my goal. I'm going to focus mostly on clinical contexts and classic presentations of certain things, right? That relates to the Upper Limba Natham. So this is probably a podcast that's probably the most useful for a person studying for the USM Lista one exam. Although this stuff is also very liable to showing up on step two, see can on step three. Fewer questions from this, but you definitely do show up on the exam. Okay, so let's go ahead and jump right into it. So what if they give you a question and they're asking about the only boony connection between the Axial and the Appendicular skeleton? What are you telling what I or should you be seeing there? Well, I would hope they are telling me that oh, you should be thinking about the clavicle, right? Remember the clavicle basically connects the manoeuvrium of the sternum, right? Remember that's like almost like the notch, right? Above the sternum, right?

So like the manoeuvrium of the sternum to the acromion of the scapula. That's the connection that's made by the clavicle. Now, what if they give you a question about a person that has a rotator cough tear? What is the most frequently torn rotator cough tendon? Well, I really hope you're telling me oh, the vine is it's super spineitis, right? And I guess if they're trying to ask you, oh, what are the contents of the rotator cough? Well, that's easy, right? You should be thinking about again, your sits nomonic, right? You've probably heard of sits, right? So we have like super spineitis, if first spineitis, teris minor and the sub scapularis, right? So super and first spineitis, teris minor and sub scapularis, right? And then what if your friends at the NV Me give you a question about a patient and they tell you that, you know, the patient has like hypertrophy of certain muscles of the neck and then the presence that's having bricchioplexes symptoms. If you see this, I'd hope you're thinking about the anterior and the middle scaling muscles, right? The anterior and the middle scaling muscles. Remember those muscles, the, basically the bricchioplexes passes between those two muscle bellies and only passes between those two muscle bellies. If those muscles are hypertrophied or they have like some problem with them, that can actually cause an impingement on the bricchioplexes.

And then what if they give you a question about a patient and they tell you that, oh, this patient is unable to extend his wrists. I'll say that again, this patient is unable to extend his wrists. Basically, this patient has wrists to drop. What should you be thinking about on NV Me exams? Well, I'd really hope you're saying, oh, divine, this sounds an awful look like a radio nerve injury, right? Remember, radio nerve injury can be something you see in people that, you know, have slashed the arrest, less than a person that has like a borderline personality disorder on an NV Me exam, right? And then they get a wrist drop. Although, classically, lead poisoning is also associated with a wrist drop on an NV Me exam, right? Because lead can cause, lead poisoning can definitely cause a neuropathy. Okay, now what if they give you a question and they say, oh, what's the nerve that innervites the anterior compartment of the arm, right? That innervites the anterior compartment of the arm, right? Remember, your arm is basically from your shoulder to your elbow. I hope you're telling me the Moschilocutaneous nerve, right? So basically, most flexing actions that involve your arm, right? I'm going to depend on appropriate functioning of the Moschilocutaneous nerve, right? And then, I guess as a corollary here, what are the three high-yield muscles on NV Me exams that are innervited by the Moschilocutaneous nerve? Well, I'll hope you're telling me that it's just think of BBC, right?

Like the TV network, BBC, right? So the biceps, the brachialis, and the coracobrachialis, right? So biceps, brachialis, and coracobrachialis. Okay, and then what is the cord of the brachialis that creates the Moschilocutaneous nerve, right? What's the cord of the brachialis that creates the Moschilocutaneous nerve? Well, I hope you're telling me that, oh, divine, this sounds a lot like the lateral cord, right? The lateral cord, right? The lateral cord of the brachialis creates the Moschilocutaneous nerve. And then, just like we say that, oh, the Moschilocutaneous nerve is the nerve of the anterior compartment of the arm. What is the nerve of the posterior compartment of the arm? Right? So like, the essentially the nerve that does extension work, well, I really hope that you're telling me that, oh, divine, this is the radion nerve, right? So again, remember, just remember the word, mister, right? MR, mister, right? So the anterior compartment of the arm is innervited by the Moschilocutaneous nerve, the posterior compartment of the arm is innervited by the radion nerve, right? And again, a nice handy dandyro to know is all the muscles of the anterior compartment of the arm, the involved in flexion, all the muscles of the posterior compartment of the arm, the involved in extension for the most part. That's like a nice general to kind of keep, keep at the back of your mind, right?

And then, you know, occasionally, they may ask about some of these, like, there's this weird muscle, the anconius muscle, right? That actually is innervited by the radion nerve as well. And don't forget, right? Your triceps, right? Is innervated by the radion nerve. Okay. And then, what if they give you an imbini question that involves you having to have knowledge of the blood supply, all the ways from the subclavian artery to the owner artery, right? So how can you trace the blood supply from the subclavian artery to the owner artery? Well, remember, you studied your subclavian artery first, right? And then around the lateral border of rib one, it becomes the axillary artery, right? So around the lateral border of rib one, your subclavian becomes the axillary artery, right? And then, remember that around the inferior border of your teris major, so, okay, let me maybe study this way. So we have the subclavian artery first, right? That's the first artery we see. And then around the lateral border of rib one, it turns to the axillary artery. And then around the inferior border of your teris major muscle, sorry, I'm just trying to sit up elsewhere. So around the inferior border of the teris major muscle, right? It then changes and becomes the axillary artery, right? And then remember, your axillary artery then becomes your brachial artery. And then after your brachial artery, you then form your radial and your owner arteries, right? You form your radial and your owner arteries.

Now, what is the high-year blood vessel on in-beaming exams that travels with the radion nerve? What is the high-year blood vessel on in-beaming exams that travels with the radion nerve? Well, I hope you're saying, oh, divine, it's the deep brachial artery, right? Remember sometimes on exams, if they want to mess with your head, they'll call it the profunda brachial, right? You'll call it the profunda brachial. And then, what is the chord of the brachial plexus that supplies the axillary nerve? What's the chord of the brachial plexus that supplies the axillary nerve? Well, I hope you're telling me that oh, divine, it's the posterior chord, right? In fact, let me ask you this. What is the other nerve that's supplied by the posterior chord of the brachial plexus? Is the radion nerve, right? Is the radion nerve? And then, if you think about it, what are the chords of the brachial plexus that supply the median nerve? What are the chords of the brachial plexus? So notice I didn't say chord. I said chords. What are the chords of the brachial plexus that supply the median nerve? I'd really hope you're saying, oh, divine, it's the lateral and the medial chords, right? Remember, the lateral and the medial chords they both contribute to forming the median nerve, right? And then, what's the chord of the brachial plexus that supplies the all-ner nerve, right? The all-ner nerve. Remember, the all-ner nerve does a lot of stuff that's medial, right?

Like, it's like medially oriented, right? So it makes sense that it's the it's the medial chord, right? So again, posterior chord is axillary and radial. Medial and lateral chords is median and then the medial chord is the all-ner nerve. The medial chord is the all-ner nerve. Now, what if they tell you they give you a question and they say, oh, what are the nerves and what's the nerve and the artery associated with a fracture of the surgical neck of the humerus, right? A fracture of the surgical neck of the humerus. Well, I hope you're telling me that, oh, divine, you know, if you fracture the surgical neck of the humerus, we're going to have problems with the axillary nerve, right? With the axillary nerve. And then the artery should be keeping at the back of your mind there is the posterior circumflex, humeral artery, right? The posterior circumflex, humeral artery. I'll see that again, the posterior circumflex, humeral artery. Again, these things that I'm saying in this podcast, I can pretty much almost promise you. You're going to see a lot of this stuff tested on your USMEL exam, especially step one, right? So just look at this as the kind of thing you're like, oh, as I'm driving to my test center or something or the deep before, I'll just pass through this. A lot of this stuff is just higher than just said, you know, let me essentially curate like the high-yield stuff that you love to walker with the upper limbs and just kind of talk you through it in a podcast.

Again, for some people, this method of learning works, works extremely well, extremely well for them, right? And again, remember, another way you can also enjoy the axillary nerve on in-beaming exams is if you have an anterior dislocation of the shoulders, right? If you have an anterior shoulder dislocation that can, you know, mess up a person's axillary nerve. So I guess you may ask yourself, okay, divine. What is the most common kind of shoulder dislocation? I hope you're telling me that it's anterior, right? Most shoulder dislocations anterior, again, this is a rapid review, but if you really look at the anatomy of the shoulder, right, the best point of weakness, right? Like basically the point where like if the shoulder were to get this engaged, if we were to move, it would likely move down and forward, right? You would likely move down and forward. That's why anterior shoulder dislocations are more the most common, right? But on NV Me exams, what are the things that will cause a posterior shoulder dislocation? That's actually pretty easy. Just think of the word electricity. Anything that involves electric phenomena will cause a posterior shoulder dislocation on NV Me exam. Being struck by lightning, right? Will cause a posterior shoulder dislocation. Having seizures will cause a posterior shoulder dislocation. Being electrocuted will cause a posterior shoulder dislocation on an NV Me exam.

Okay, now what if they give you a question about the nerve and the artery that are associated with a spiral fracture of the humerus, right? A spiral fracture of the humerus, right? Sometimes they may say, oh, like a mid-shoff fracture of the humerus. If you see this, you want to think about a problem with the radio nerve, right? And again, that deep brachial artery. Remember that deep brachial artery? We said it's also called profunda brachia, right? We said it's also called profunda brachia. Okay, now what's the nerve and the artery associated with a superconductor fracture of the humerus, right? So what's the nerve and artery? As you know, the superconductor fracture of the humerus. Well, I hope you're telling me this one is pretty easy, right? This is going to be the median nerve, right? And what's the artery that tags along there? It's the brachial artery, right? So the median nerve and then the brachial artery. Okay? Now what is the nerve lesion so they can even give you a question about a person? It's really that she has gone for like some kind of breast surgery, like a mastectomy or something like that or like some kind of lymph node dissection. And then they tell you that, oh, you can see these bulges or the upper part of her back. What are you thinking about there? Well, I really hope you're telling me that, oh, divine. This looks an awful lot like winged scapula, right? Like winged scapula. It's a common complication on an in-beaming exam so breast surgery, right?

It usually causes a long, it's caused by a long thoracic nerve pulsing, right? So problems with a long thoracic nerve. I remember the long thoracic nerve supplies the seredos anterior muscle, right? In fact, you probably have heard of this salt no money, right? S-E-L-T, right? Seredos anterior is the S-A and then L-T is the long thoracic, right? L-T is the long thoracic. Again, very, very high yield to give that at the back of your mind for, for example, right? And then your friends at the in-beaming exams, the love, arm, abduction, right? I'm sure you've seen this question, abnozzam on your test. If you're not using it, you're using it. So, you're using it. So, you're using it. You're using it. So, you're using it. You're using it. You're using it. You're using it. You're using it. So, you're using it. You're using it. You're using it. You're using it. You're using it. So, you're using it. You're using it. You're using it. You're using it. So, you're using it. You're using it. You're using it. You're using it. So, you're using it. You're using it. You're using it. The near test, right? Just something to keep at the back of your mind for, for example, purposes, right? So, supress by in-early, provides the first 15 degrees of arm abduction, right? And then what's the thing that provides 90 degrees of arm abduction? Well, I hope you're telling me it's the deltoid, right? It's the deltoid, right? So, that's going to be a problem with the axillary nerve.

So, the thing is, if a person can initiate shoulder abduction, but they cannot go more than 15 degrees, you want to think about an axillary nerve pulsing, right? You want to think about some kind of deltoid paralysis, right? Some kind of deltoid paralysis. And then what are the boundaries of the quadrongular space, right? What are the boundaries of the quadrongular space? Well, first things first, I guess, let's ask ourselves, what in the world is the quadrongular space? The thing is, there are many spaces around the shoulder. And for the most part, these spaces, they are bordered by the triceps, right? So, I'm just giving you that general bit of information, just in case, you know, your brain is kind of playing tricks on you on the exam so that you don't, you know, kind of miss things up, right? But in general, there are a bunch of very key, high-yield spaces that you may see on ambient exams in the shoulder, right? There's the quadrongular space, which is probably the most important, and that's where I'm going to spend time on. But there is also like the triangular space, right? There's the quadrongular space, there's the triangular space, and there's even something called the triangular interval, right? But again, I think that's kind of beyond the scope of our discussion today. So, I'm just going to focus on the quadrongular space, right? So, the quadrongular space has many borders, right? So, it has a superior border, right?

It has an inferior border, it has a medial border, and it has a lateral border, right? Again, it's one of these rare things that, again, you may not see many resources, but it's actually kind of high yield to know for the USMLE exams, right? So, the thing is what's the superior border? Well, the superior border of the quadrongular space, and I guess maybe let me say this, what passes through set quadrongular space, right? Like, if it's just a space, woohoo, who cares, right? But we do care, right? Because it transmits your auxiliary nerve, right? And in addition to transmitting your auxiliary nerve, it also transmits your posterior circumflex-humeral artery, right? So, it transmits your auxiliary nerve and your posterior circumflex-humeral artery, okay? Your auxiliary nerve and your posterior circumflex-humeral artery, right? So, those are the things that cough through your quadrongular space. So, again, what's the superior border? Well, the superior border is going to be your sub-scarplaris and your teris minor muscle, right? Your sub-scarplaris and your teris minor muscle, right? And then your inferior border is actually going to be your teris major muscle, right? Your teris major muscle, right? And then your medial border is actually going to be the long head of the triceps brachii, and then the lateral border is going to be the surgical neck of the humerus, right?

And again, remember, again, maybe this may give you like a nice memory to remember whenever you fracture the surgical neck of the humerus, that's how you're going to be injuring the auxiliary nerve, right? That's how you're going to be injuring the auxiliary nerve, right? So, again, our repeats. The superior border of the quadrongular space is sub-scarplaris and teris minor, the inferior border is teris major, right? The medial border is the long head of triceps brachii, and the lateral border is the surgical neck of the humerus. Again, don't forget that auxiliary nerve relationship, right? And then, again, like I've said before, what's the most common kind of shortage? There are certain things you may see me repeat here. The reason I'm going to keep repeating them is again, unfortunately, you know, MSK, you know, sadly, you know, sometimes it kind of depends on having to memorize quite a number of things, right? So, I feel like repetition and maybe going to lose slower may not be the, you know, be the worst thing in the world, right? So, what is the most common kind of, of shoulder dislocation, right? What is the most common kind of shoulder dislocation? Again, as I've said, it's going to be an anterior shoulder dislocation, right? So, there'll be an anterior shoulder dislocation. In fact, more than 90% of shoulder dislocations are anterior shoulder dislocations, right?

And again, the reason if you really dig deep, again, I'm not going to go super, super deep on this, but if you really dig deep is because most parts of the shoulder joint, for the most part held, for the most part held by the rotator cuff. And unfortunately, the rotator cuff is less than adequate reinforcement for the, for the shoulder joint, right? So, that's why, again, most, like really most parts of the shoulder, you know, like the lateral shoulder, the medial shoulder, the posterior shoulder, those are, you know, appropriately reinforced by the rotator cuff, but the anterior part of the shoulder is really has almost no reins reinforcements by the rotator cuff. That's why most people tend to have, if they have shoulder dislocations, they're going to have it anteriorly, right? They're going to have it anteriorly, right? Now, let's talk about a key anastomosis in the, in the, in the, in the upper extremities, right? So, what's the scapular anastomosis? Where was the scapular artery anastomosis? Was the scapular artery anastomosis? So, remember, you're subclavian artery, right? It gives rise to an artery called a thyracircule trunk or a seat like a body of arteries called a thyracircule trunk. And then, that thyracircule trunk then gives rise to the supras scapular artery, right? And then, the supras scapular, look at the name supras scapular above the scapular, it's superior to the scapular, right? The supras scapular artery, right?

It goes over the superior border of the scapular, and then when it does that, it supplies blood to the supra and infraspinitas, right? And then, remember that that supras scapular artery, right? Which goes over the superior border again, of the scapular to supply the supra and infraspinitas. Anastomosis with the scapular, the scapular circumflex artery, right? Which, it kind of meets on that the infraspinitas, most remember, your infraspinitas is one of those things that constitute your, your tyracoph, right? So, again, your supras scapular artery anastomosis with your scapular circumflex artery. It does this right under the infraspinitas muscle again. This very specific anatomy questions, the things that you see more in the purview of the USM list, one example, exactly, right? So, again, supra scapular artery gives rise to your thyracircule trunk, and then that gives rise to your supras scapular artery, right? The supras scapular artery will climb over the top of the scapular, that's what's called supras scapular, right? It will supply the supra and infraspinitas muscles, but right under the infraspinitas muscle, it parties up with the scapular circumflex artery, and then deform an anastomosis, right? And then, what's the muscle that does most things for your arm, right? Let me just give that as a general thought. What's the muscle that does most things for your arm? I'm going to hope your telling me, oh, the vine is going to be the deltoid, right?

And in your deltoid, those like a ton of stuff, right? In fact, I remember it with the name fear, right? So, the deltoid is a very big powerful muscle, so it puts fear in you, right? So, the F is for flexion, right? The E is for extension, the A is for A Bduction, right? And then the R is for rotation, it does both medial and lateral rotation of the arm, right? So, again, remember your deltoids, right? Just think of like some big muscular guy that is kind of freaking you out because he has like super, super large muscle, right? So, think of that guy as having super large deltoids, right? So, deltoids put fear in you, they help with flexion of the arm, with extension of the arm, with A Bduction of the arm, and with rotation of the arm, both medial and lateral rotation, right? Now, because this deltoid is so important, what is the what is the blood and nerve supply of the deltoid muscle? Right? Remember, the blood supply of the deltoid muscle, again, is something that you should know in, because again, think about it, actually, nerve, right? Does the deltoid muscle? So, it would make sense that the artery that runs with the axillary nerve must be the one supplying the deltoid muscle. In this case, that's going to be the posterior circumflex-humeral artery, right? That's going to be the posterior circumflex-humeral artery. That's going to be the posterior circumflex-humeral artery. Okay, now, what is the thing that the muscle that AD dots, right?

So, we've talked about arm A Bduction, what was the thing that AD, right? AD, like Anthony Davis, you know, I've a big Lakers fan of Somovianel, right? So, what's the thing that AD dots and medially rotates the arm? What's the thing that AD dots and medially rotates the arm? Well, I really hope you are saying, oh, divine, this is teris major, right? This is teris major, this is teris major, right? So, teris major adopts AD, like, AD double D, right? So, it adopts and medially rotates the arm, and remember, teris major is actually supplied by the lower sub scapular nerve, right? The teris major is supplied by the lower sub scapular nerve. So, what's the thing that supplies teris minor? I don't be telling me it's axillary nerve, right? Again, many people probably remember the security company ADT, right? ADT, the security company, right? So, A is for axillary nerve, well, axillary nerve supplies the D, deltoid, and the T teris minor, right? So, teris minor supply by the axillary nerve, but the teris major is supplied by the lower sub scapular nerve, right? And then, what is the name of the muscle that laterally rotates the arm, right? Laterally, again, there are many things that laterally rotate the arm, maybe let me give you an extra hint. This thing is actually innervated by the supress scapular nerve. Well, I hope you are saying, oh, divine, okay, easy, this is infraspinatus, right?

So, remember, infraspinatus is a lateral rotator of the arm, and it's supplied by the supress scapular nerve, right? And they remember that teris minor also laterally rotates your arm, right? Teris minor also laterally rotates your arm, and it's actually innervated by the axillary nerve, again, as we've described, right? So, what are the things that are your lateral arm rotators? I hope you are saying, oh, divine, I remember this with a term DIT, right? DIT, right? So, the D is going to be for your deltoid, remember your deltoid can both medially and laterally rotate the arm. I stands for your infraspinatus, and then T stands for your teris minor. These are all things that have the ability to laterally rotate the arm, but remember the deltoids in addition to being able to laterally rotate your arm can also medially rotate your arm, right? Can also medially rotate your arm. Now, what is the name of the muscle that can medially rotate and adduct your arm, right? And it's actually innervated by both the upper and the lower sub-scapular nerves. Well, that's easier. That's going to be the sub-scapularis, right? That's going to be the sub-scapularis, right? So, remember the sub-scapularis medially rotates your arm, but it also adducts your arm, right? And it's actually innervated by the, again, the upper and the lower sub-scapular nerves.

If you notice, a lot of what I'm doing in this podcast, because again, you see people when they are trying to learn muscleoscalotel anatomy or anatomy in general, they just try to like rotememorize it. To be honest with you, that's maybe not the most prudent thing in the world to do. Usually, the best way to learn anatomy is to be able to make group things, right? Especially MSK anatomy, because I know it's the pain of many people's existence in med school, right? Just go ahead and group things together and then try to make some very useful comparisons, right? So, we just said that sub-scapularis adducts and medially rotates the arm. And we said it's supplied by the upper and lower sub-scapular nerves. Well, remember the deltoids have the ability to medially rotate the arm. But what do they do to the arm? Instead of adduction, your deltoids cause AB, like abs, AB,duction of your arm, right? And your deltoids, again, as I said, are innervated by the axillary nerve, right? They are innervated by the axillary nerve. Now, what is the nerve supply to the pectoralis major muscle? What's the nerve supply to the pectoralis major muscle? This is easy, right? These are your medial and your lateral pectoral nerves. Again, this can be a breast surgery question on an endemic exam because you can potentially injured those nerves in the setting of, like, a radical mastectomy or something of that nature.

And then, what are the three, I guess, let me call them high yield, humoral functions of the pectoralis major muscle. What are the key things that the pectoralis major muscle does with the humerus? Well, I hope you're saying that, oh, divine, it flexes, it adducts and immediately rotates the humerus, right? I'll say that again. So, just think of, like, family, the first three words in family, right? So, it flexes, it adducts and immediately rotates the humerus, right? So, those are higher things that are done by the pectoralis major muscle with the humerus, right? And then, what's the muscle that depresses and protracts the scapula, right? So, it brings it down, right? And then, it pulls the scapula apart. What is the muscle that does that? Well, that's going to be the pectoralis minor muscle, right? Remember, the pectoralis minor muscle is supplied by the medial pectoral nerve, right? It's supplied by the medial pectoral nerve, supplied by the medial pectoral nerve. Okay. And then, what's the blood and nerve supply for your serenity? Again, we've kind of talked about this already. Remember, your long thoracic nerve supplies your serenity, remember the salt the one we talked about? And then, just like you remember, LT for serenity, there's also an LT in terms of a teal supplies the lateral thoracic artery, right? So, the long thoracic nerve supplies the serenity and teram muscle and it's supplied by the lateral thoracic artery, right? Supplied by the lateral thoracic artery.

Okay. I think I'm going to go ahead and wrap up here very soon. Let me just do a few quick groupings for you, right? So, what are the, if they give you an in-be-me question, you're like, oh, what are the two high-yield flexors at the shoulder joint? What are the two high-yield flexors at the shoulder joint? Again, easy. This is going to be your deltoids and your pectoralis major, right? Your deltoids and your pectoralis major. Okay. Now, what are the three high-yield extensors at the shoulder joint? All right. What are the three high-yield extensors at the shoulder joint? Again, this is going to, your deltoids. Again, most things that your shoulder, if you're kind of like, I don't know what to do on the exam, just be deltoids, right? So, these are going to be your deltoids, your teris major and latissmos dorsi. Those are your three high-yield extensors at the shoulder joint, right? And then, what are your three high-yield ED doctors, ED doctors, ED like Anthony Davis, or I guess Andrew Drummond, since we've got him in the bio-market, right? So, what are the three high-yield ED doctors at the shoulder joint? Well, I think you're telling me that, oh, the vine's going to be your peck-me, your pectoralis major, your teris major, and your latissmos dorsi, right? So, your pectoralis and your teris major muscles, and then your latissmos dorsi, right? And then, what are the two high-yield AB doctors at the shoulder joint?

Again, the first one is super spineedos, it does 15 degrees, and then your deltoids wish to 90 degrees. This is almost like a review of what I've talked about already, right? And then, what are the five high-yield media rotators of the shoulder joint? We've talked about many of these already. I'll just throw into it, right? So, what are the five high-yield media rotators at the shoulder joint? Well, this is going to be your pectoralis, right? It's going to be your teris major, right? It's going to be your deltoids, right? It's going to be your latissmos dorsi and your sub-scapularis. I'll see that again, right? So, your pectoralis and your teris major, your latissmos dorsi, your deltoids, and your sub-scapularis, right? And your sub-scapularis, okay? Now, I think I should go ahead and stop here. I guess let me talk about the lateral rotators, why not? So, what are the three high-yield lateral rotators at your shoulder joint? Again, don't forget the di-tinomonic we talked about, right? So, d-for-deltoids, i-foy-infrast-pineedos, t-for-teris, why not? Okay? So, I think I'm just going to go ahead and stop here. Again, as I do at the end of every podcast, I'd go for one or one titerine for many exams, step one, step ju-c-k, and step three. Preclinical medical exams, third-year shelf exams. If you're a medicine resident, I tutor for the medicine boards and the medicine-entering exam.

And then, I have a step two-c-k-slash step three course coming up between the 20th of April and the 1st of May. It's from 11 a.m. to 4 p.m. Pacific standard time on each of those days, over Zoom. And then right before that, on the 27th of April, I have an MBME Test Tikin Strategy course. I'm going to be for two and a half hours from two to four 30 p.m. Pacific standard time. Super high-yield course. Again, I've had many people take these courses. I believe the highest score, at least that I'm personally aware of, from people that have taken my courses, the pressing go to 279 on step two-c-k, right? So, again, I've had people that have done really well from taking my course. I've had tons and tons and tons of other pool that have done well from taking my course or from getting one-on-one tutoring from so. And also, again, as Ira says, beginning to back on the loss again, again, I've worked with people that have had very tricky applications. Again, remember, I've done this for years and I've actually been on an admissions committee at a top two-med school for a whole year, right? So, again, I'm very good with applications. So, Ira's applications for people applying to residency, I'm a cast's applications for people applying to a med school. Just reach out to me. And the easiest way to reach out to me, just go to the website and then go ahead and just hit the contact button and you just shoot me an email from there. And I'm usually pretty responsive.

And then if you please subscribe to the website, again, it's on now. And I guess let me say this, especially if you have like red flags in your application, like red flags, tricky applications, oh, I failed step one the first time or why I failed step two CK the first time or why graduated from med school in a foreign country like 10 years ago, blah, blah, blah, blah, blah, blah, blah, right? Or I have to take a leave of absence or I don't have research stuff like that. Again, these are all scenarios that I've worked with people on. I mean, of these people are now residents, right? So, again, if that's something you're interested in contacting me through the website, I'll be happy to point you in the right direction. And then please subscribe to the website, Divine Intervention, USMLE podcast and videos. Whenever I make a new podcast, you'll get an email notification. And then you can also subscribe to this, this podcast on the podcast apps, right? So like Google podcasts, Apple podcasts, Spotify, I have the podcast on all of those platforms. Although I have the, I can only have the most recent 150, right? The most recent 150, right? So it's just a rule. There's literally like nowhere around it. I've tried trust me, right? So because I get emails from people all the time, like always episode one, right? It's not there, right? Sadly. And then I also have a You Tube channel, Divine Intervention, USMLE podcasts and videos, right? Divine Intervention, USMLE podcast and videos.

Because you know, there's some knockoff You Tube channels out there. If you're looking for my actual videos, look for Divine Intervention, USMLE podcasts and videos, right? Divine Intervention, USMLE podcasts and videos. Again, that's where I post my videos. And again, if you want my, like, let's say like the Power Point, so the PD Fs you find in those videos, they're going to find them on the website, right? So Divine Intervention podcasts with an S dot com. So thank you for listening. I will see you next time. I'll probably make media and other opera limbs just quick, rapid review, just to maybe hear on a few more ideas I have in my head. And then we'll kind of go from there. But again, I want to keep this short and sweet so that it doesn't become overwhelming for people. So thank you for listening. God bless you. See you next time.

The axillary nerve and the posterior circumflex-humeral artery.

Serratus anterior (due to long thoracic nerve injury).

Anterior; because the anterior aspect of the joint lacks adequate reinforcement from the rotator cuff.

Deltoid (D), Infraspinatus (I), Teres minor (T) $\rightarrow$ DIT.

Musculocutaneous nerve.

Wrist drop (inability to extend the wrist).

Supraspinatus, Infraspinatus, Teres minor, and Subscapularis (SITS mnemonic).

Superior border: Subscapularis and Teres Minor; Inferior border: Teres Major; Medial border: Long head of Triceps Brachii; Lateral border: Surgical neck of Humerus.

Ulnar nerve.

Deltoid and Pectoralis Major.

Subscapularis; it medially rotates and adducts the arm.

Axillary nerve (suggesting supraspinatus involvement).

Supraspinatus, Infraspinatus, Teres minor, and Subscapularis (SITS mnemonic).

Superior border: Subscapularis and Teres Minor; Inferior border: Teres Major; Medial border: Long head of Triceps Brachii; Lateral border: Surgical neck of Humerus.

Ulnar nerve.

Deltoid and Pectoralis Major.

Subscapularis; it medially rotates and adducts the arm.

Axillary nerve (suggesting supraspinatus involvement).