100 Concepts Flashcards
What does lumbar puncture (tap) and Epidural Anesthesia mean and where is it performed?
Lumbar puncture (tap):
- Extract Cerebrospinal Fluid (CSF)
- Enters the Subarachnoid Space
- Done between L4/L5
- Level of horizontal line through upper points of iliac crest
Epidural Anesthesia:
- Inject Anesthetics to epidural space
- Enters the epidural region
- Done between L3/L4
Adults -> spinal cord ends as low as L2
Children -> ends at L3 and dural sac extends caudally to the level of S2
Extra info:
- the injection goes through -> skin -> fascia -> supraspinous ligament -> Interspinous ligament -> ligamentum flavum -> epidural space -> subarachnoid space
- Filum terminale continues past the dural caudal sac all the way to S4 -> but the dural caudal sac is the important part, as it contains the CSF and in children as mentioned earlier, goes all the way until S2
- You do the test at those parts because you don’t want to injure the filum terminale? because towards the end dural sac is smaller so more chance of needle hitting the nerve…?
What are herniated IV discs and where do they occur?
- Back pain history? -> typically herniated discs
- Herniated discs happen at C5/C6, C6/C7, L4/L5 or L5/S1 -> age younger than 50
- Herniated discs INJURE the nerve root one below (traversing root)
E.G… Herniation at L4/L5 will compress root at L5 - Pain begins soon after patient lifts something heavy, and lower limb reflexes are decreased on the affected side
Extra Info:
- The herniation breaks through the enclosing ANULUS fibrosus (covers the nucleus pulposus) -> nucleus pulposus (inner core of vertebral disc) herniates past the posterior longitudinal ligament affecting the traversing root, and protruding from the vertebral canal
- Herniations can be due to DEFECT in anulus fibrosus
What are the different abnormal curvatures of the spine?
Kyphosis:
- Exaggeration of thoracic curvature
- Result of osteoporosis in older people (multiple compression fracture of vertebral bodies)
- Results also from disc degeneration
- Looks like your neck droops and your back is more upwards (looks like that dwarf rejected spartan from 300 movie)
Lordosis:
- Exaggeration of lumbar curvature
- Due to pregnancy, pot belly, spondylolisthesis ( forward displacement of vertebra)
- “Walk like a lord”
Scoliosis:
- Lateral deviation of spine
- Due to poliomyelitis, leg length discrepancy, or hip disease
- “S shaped ish spine”
What is the anatomy of a humerus? What are the different upper limb humerus fractures?
Anatomy:
- starts of with the head, and right after is the anatomical neck
- Then you have the greater and lesser tubercle
- Then comes the surgical neck (axillary nerve)
- Then comes the shaft which has the deltoid tuberosity (radial nerve)
- Then, the supracondyles
- Lastly, the medial and lateral epicondyle (ulnar runs through medial epicondyle)
Fractures:
- Axillary and Posterior humeral circumflex artery at the surgical neck
- Radial nerve and profunda brachii artery at
midshaft, also affects the origin of brachialis muscle - Brachial artery, Median nerve affected at the supracondylar region (lateral?)
- Ulnar nerve, at medial epicondyle
What are the different fractures of distal radius?
- Transverse Fracture within 2cm of the distal radius -> most common fracture of forearm (after 50)
- Smith’s Fracture -> fall or blow on dorsal aspect of flexed wrist -> ventral ANGULATION of wrist -> distal fragment of radius ANTERIORLY displaced
- Colles’ Fracture -> forced extension of hand, result of trying to ease a fall by outstretching the upperlimb -> distal fragment displaced DORSALLY -> “Dinner Fork Deformity” ulnar styloid process avulced (broken off)
What are carpal bones? What is a scaphoid fructure?
Carpal Bones from thumb side to pinky and then back from pinky to thumb:
“So long to pinky” -> Scaphoid, Lunate, Triquetrum, Pisiform
“Here comes the thumb” -> Hamate, Capitate, Trapezoid, Trapezium
Scaphoid Fracture:
- Fall onto palm when hand is abducted
- Pain at the lateral side of the wrist during wrist extension and abduction
- Scaphoid fracture may not show 2-3 weeks, but a deep tenderness will be present at ANATOMICAL SNUFFBOX
- Proximal fragment may undergo avascular necrosis because blood supply interrupted
- Anatomical snuffbox -> Radial Artery
What is a Boxer’s fracture?
- Neck of the metacarpal (knuckles?), frequently fractured during fist fights
- Typical fractures -> 2nd / 3rd metacarpal -> professional boxers
- 5th and sometimes 4th metacarpal -> unskilled fighers
What is a mallet/ baseball finger?
- Distal interphalangeal joint suddenly has EXTREME flexion (hyperflexion), “when cricketers get hit my ball”,
- Avulse the attachment of extensor digitorum tendon, base of the distal phalanx
- Person cannot extend DIP joint
- Deformity resembles a mallet (hammer), cause the finger bends down and makes the hammer head looking thing
What are the rotator cuff muscles? And what is its’ function?
- Supports the joint by forming a musculotendinous rotator cuff around it
- Reinforces joint on all sides, except inferiorly -> INFERIORLY is where dislocation mostly occurs
"SItS" Supraspinatus - Abducts 15 degrees Infraspinatus - lateral rotation Teres Minor - lateral rotation Subscapularis - ?
“too understand the insertion, just picture a hand holding onto the humerus, thumb to ring finger, (thumb on lesser tubercle, first finger on greater) and imagine SItS”
Nerve: For supraspinatus, infraspinatus -> Suprascapularis
Nerve: For teres minor -> Axillary
Nerve: For subscapularis -> subscapular nerve
How do you abduct the upper limb?
- Supraspinatus muscle -> 15 degrees -> Suprascapular nerve
- Deltoid muscle -> 15-110 degrees -> axillary
- Serratus anterior (long thoracic nerve) “affected during mastectomy” “can’t comb hair” and Trapezius (CN11 ACCESSORY) -> 110 - 180 degrees
What is subacromial bursitis / tearing of supraspinatus tendon?
- Subacromial bursitis is due to calcific supraspinatus tendinitis. This causes painful arc of abduction.
- Same symptoms are seen in inflammation or trauma of supraspinatus tendon (MRI -> Torn Tendon)
What is a three elbow’s/ students elbow?
- Subcutaneous olecranon bursitis is another name for three elbows/ students elbow
- The olecranon is where the tricep attaches distally
- Easily palpatable, it is seperated from the skin via the olecranon bursa (helps the elbows have mobility)
- Excessive pressure and friction -> bursa inflamed
- Thus, friction subcutaneous olecranon bursitis
What is a lateral epicondylitis (tennis elbow)? What are the effects?
- Lateral epicondylitis is due to repeated flexion and extension of wrist, resulting strain attachment of common extensor tendon.
- Inflamed periosteum of lateral epicondyle. Pain felt on the lateral epicondyle and felt down the forearm (pain in opening door, lifting glass)
- Origins of muscles affected: extensor carpi radialis longus, extensor carpi radialis brevis, extensor ulnaris, extensor digitorum, extensor digiti minimi
What is a medial epicondylitis (golfers elbow)? What does it affect?
- Inflammation of common flexor tendon of the wrist
- Origins of muscles affect -> Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris
What is the arterial anastomoses around the scapula?
- When subclavian artery or the axillary artery is blocked anastomoses is possible! Via thyrocervical and subscapular branches
- Subclavian Artery Side:
From the subclavian artery, thyrocervical trunk comes out and branches to transverse cervical artery and suprascapular artery. These go to the middle and anastomose with the other side, and also transverse cervical goes way below to become dorsal scapular artery and intercostal arteries - Axillary artery side
From the axillary artery, branches out the subscapular artery which goes all the way down as thoracodorsal artery, and before it does that, it branches as circumflex scapular artery and meets in the middle with transverse cervical and suprascapular.
Describe the cubital fossa and its’ contents!
- Lateral to medial
Biceps brachii tendon
Brachial Artery
Median Nerve
-Subcutaneous Lateral to Medial
Cephalic vein
Medial cubital vein
Basilic vein
- Sites of venipuncture (blood sample?) -> medial cubital vein
Overlies bicipital aponeurosis, therefore deep structures protected AND ALSO not accompanied by nerves
What is carpal tunnel syndrome?
- Lesion that causes the carpal tunnel to reduce in size or narrow (fluid retention, infection, lunate bone dislocation)
- Median nerve most sensitive structure in the carpal tunnel and mostly affected
- Clinical -> Pins and needles, anesthesia, of lateral 3.5 digits, PALM sensation not affected because superficial palmar cutaneous branch runs superiorly to the carpal tunnel
- Ape hand deformity -> Absence of opposition
How do you test for the proximal and distal interphalangeal joints?
- Proximal
You test the flexor digitorum superficialis (FDS), this is done by extending all your fingers and letting the middle finger flex via the proximal joints only
-Distal
You test the flexor digitorum profundus (FDP), done by holding the middle finger and letting the patient flex just the top “distal phalangeal joint” part of the finger
