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msk and ct - step > anatomy and physiology - upper limb > Flashcards

anatomy and physiology - upper limb Flashcards

1
Q

positive anterior drawer test meansÉ

A

ACL damage

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2
Q

describe how to perform the anterior drawer test

A

patinet supine, knee bet at 90 degress

angerior glindign of tibia

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3
Q

psoterior drawer sign positive

A

pcl damage

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4
Q

describe attachemtn of acl and pcl on tiba

A

anterior on tiba - acl
posterior on tibia - pcl
hurrah

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5
Q

how to assess mcl damage

A

abnormal passive abduction: patinet supie, knee extended or at 30 degress
apply lateral/valgus force - if results in medial space widening of tibia = mcl damage

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6
Q

how to assess lcl damage

A

abnormal passive adduction: patient supine, knee extended or at 30 degrees.
apply medial/varus force - if results in lateral space wideing of tibia - lcl damage

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7
Q

what is the mcmurray test

A

with patine supine and knee internally and externally rotated during motion
external rotation = pain and pop = medial
internal rotation = pain and pop = lateral

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8
Q

what type of trauma causes the unhappy triad

A

common in contact sprots due to lateral force applied to a planted leg

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9
Q

what injuries constitute the unhappy triad

A

damage to the ACL, MCL and medial lemnisucs (but mor ecommonly the laterla mensicus is injuered even though it is not attaced to the mcl)

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10
Q

acute knee pain

signs of joint injuery and instability

A

unhapy triade

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11
Q

list the physical examination positive in the unhappy triad

A

ACL: positive anterior drawer
MCL: medial space widening of tibia/abnormal passive abduction when lateral/valgus force applied
medial menicus: external rotation - pop and pain
laterla meniscus: internal rotation - pop and pain

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12
Q

housemaids kneww

A

prepatellar bursisits

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13
Q

repreated trauam ro pressure from extensive kneelign

A

prepatellar bursitis

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14
Q

popliteal non pulsaltie fliud collection

A

baker cyst

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15
Q

arthritis associated with baker cyst

A

rheumatoid arhtiritis

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16
Q

what are baker cysts usually associated with?

A

chronic joint disease.

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17
Q

list the rotator cuff muscles and their innervation please

A

supraspinatus - suprascapular nerve
infraspinatus - suprascapular nerve
teres minor - axillary nerve
subscapularis - upper and lower subscapular nerves

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18
Q

list the rotator cuff muscels and their function please

A

supraspinatus - 0-15 abduction
infraspinatus - lateral rotation
teres minor - lateral rotation and adduction
subscapularis - medial rotation and adduction

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19
Q

list the rotator cuff muscles and their function please. weak last time :)

A

supraspinatus - 0-15 abdocution
infraspinatus - lateral rotation
teres minor - lateral rotation and adduction
subscapularis - medial rotation and adduction

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20
Q

list the rotator cuff muscles, innvervation, function and common injuries

A

suprascapularis/suprscapular/ abduction 10-15 degrees/most commonly injuered/empty can- full can assessment
infraspinatus/suprascapular/lateral rotation/pitchign injury
teres minor/axiallary nerve/lateral rotation/adduction
subscapularis/upper and lower subscapular nerves/medial rotation and adduction fo arm

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21
Q

what nerve roots primariy innervate teh rotator cuff muscles

A

C5 and C6

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22
Q

golfers elbow aka

A

medial epicondylities

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23
Q

what type of action causes golfers elbow

A

repetitive flexion aka forehand shots

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24
Q

how to reproduce pain in golfers elbow

A

flex hand and supinate arm

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25
Q

tennis elbow aka

A

lateral epicondylitis

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26
Q

what type of action causes tennis elbow

A

repetitive extension aka backhand shots/hammer and screwdrive repetitive use says glojan…

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27
Q

how to reproduce pain in lateral epicondylitis

A

gripping

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28
Q

list the wrist bones please

A

lateral/proximal: scaphoid - lunate - traquitrum - pisiform

lateral/distal: trapezium - trapexoid - capitate - hamate

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29
Q

what bones make up the wrist joint

A

scaphoid, lunate and radial bone

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30
Q

what carpal bone is palpated in the anatomic snuff box

A

scaphoid

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31
Q

what are the borders of the anatomic snuff box

A

posterior = tendon of extensor pollicus longus

anterior: extensor pollicus brevis and abductur pollicis longus
proximal: styloid procress of radius
distal: apex of trinagle
floor: trapezium, scaphoid can be palplated

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32
Q

whats the big deal abotu the blood supply of the scaphoid

A

received it distally. if fractured, proximal portion can become necrotic.

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33
Q

what can happen from the lunate becoming dislocated

A

can cause acute carpal tunnel syndrome

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34
Q

what causes acute carpal tunnel syndrome

A

dislocation of the lunate.

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35
Q

fall onto an outstreched hand

A

can damage the hook of the hamate = ulnar nerve injury

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36
Q

what sort of injury can cause distal damage of the unlar nerve

A

fall onto an outstretched hand - damages the hook of the hamate.

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37
Q

entrapment of median nerve in the carpal tunnel

A

carpal tunnel syndrome

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38
Q

how does carpal tunel syndrom present?

A

paresthesia, pain and numbess in distribution of median nerve - roughly 123.

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39
Q

causes of carpal tunnel

A

pregnancy
rheumatoid arhtritis
hypothyroidisi
repetitive use

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40
Q

what can these conditiosn be associated with?
pregnancy
hypothyroidism
rheumatoid arthritis

A

and repeititve used

carpal tunnel syndrome

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41
Q

what is guyon canal syndrome

A

compression of ulnar nerve at wrist or hand

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42
Q

what injury common seen in cyclists (involving wrist)

A

bucks fascia ;)
guyan canal syndrome from pressure in the handle bars
compression of ulnar nerve at wrost or hand

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43
Q

list the nerve roots:

a) axillary
b) musculocutaenous
c) radial
d) median
e) ulnar
f) recurrent branch of median nerve

A

a) axially - C56
b) MC - C567
c) radial = C5678T1
d) median = C5678T1
e) ulnar = C8T1
f) recurrent branch of the median nerve = C5678T1

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44
Q

fractured surfical neck of humures

A

axillary nerve

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45
Q

anterior dislocation of the humerus

A

axillary nerve

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46
Q

upper trunk compression

A

musculocutaneous nerve

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47
Q

midshaft fracture of the humuros

A

radial nerve

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48
Q

compression of axialla

A

radial nerve

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49
Q

saturday night palsy

A

compression of axilla @ crutches or sleepign with arm over chair - radial nerve

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50
Q

supracondylar fracture of humurus

A

proximal lesion of median

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51
Q

carpal tunnel syndrome

A

distal lesion of median

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52
Q

wrist lacteration

A

distal lesion of median never

53
Q

fracture of medial epicondyle of humurus

A

proximal ulnar n lesions

funny bone

54
Q

fracture hook of hamate

A

distal ulnar lesion

55
Q

superficial laceration of palm

A

recurrent branch of media nerve

motor only to oaf

56
Q

injurty to axially nerve caused be?

A

fracture surgical neck of humerus and anterior dislocation of humerus

57
Q

injuery to MC nerce can be caused by

A

upper trunk compression

58
Q

injurty to radial never can be caused by

A

compression of axilla

midshaft fracture of huermus

59
Q

injury of median nerve caused be?

A

proximal - suprcondylar fracture of humerus

distal - carpal tunnel syndrome, wrist laceration

60
Q

injury of ulnar nerve caused by?

A

proximal - fracture of medial epicondyle of humerus

distal - fractured hook of hamate

61
Q

damage to recurrnet branch of median nerve caused by

A

superficial laceration of plam

62
Q

axiallry nerve damage rpesentation

A

loss of deltion and teres minor
flattened shoulder
no abduction at shoulder above 15 degrees
no sensation over deltoid muscla and lateral arm

63
Q

what sensory areas is axillary nerve responsbile for

A

lateral arm and over deltoid muscle

64
Q

presentation of musculocutaneous nerve damage please

A

loss of forarm flexion and supination

loss of sensation fo lateral forarm

65
Q

sensory distribution of musculocutaneous nerve pelase

A

lateral forearm

66
Q

presentation of radial nerve damage

A

wrist drop - loss of elbon, wrist and finger extesion
decreased drop strenght bc wrist extension needed for maximal action fo flexors (think of hanging off a cliff ;) )
loss of senation over psoterior arm and forarm and dorsal hand

67
Q

sensory distribution of radial nerve please

A

posterior arm
posterior forearm
dorsum of hand

68
Q

ape hand

A

recurrent of median and up

69
Q

popes blessing

A

median nerve

70
Q

presentation of median never damage

A

loss fo wrist felxisoin, flexion of lateral fingers, thumb opposition, lumibcals fo second and third digits
tinel and phalen sign positive - tingling.

71
Q

what is the action of the lumbricals

A

flex at MCP

extend and DIP and PIP

72
Q

presentation of ulnar nerve damage

A

ulnar claw on digit extension
radial deviation of wrist upon felxion - proxial lesion
loss fo wrist flexion, felxion of medial fingers, abduction and adduction fo finers at interossei, action of medial 2 lumbricals - flex MCp and extend DIP and PIP
loss of sensation over medial 1/5 fingers including hypthenar eminence

73
Q

what is sensory distribution of ulnar nerve

A

sensation over medial 1/5 fingers including the hypothenar eminines @ PALMAR
sensation over the 5th, 3/4rds of 4th and 1/8th of 3rd finger and all of hand prox to those digits on dorsal side

74
Q

what ise sensory distribution of median nerve

A

tehnar eminnens and dorsal and plamar aspects of lateral 3/5 fingers with proximal lesion

75
Q

presentation of damage to recurrnet medial nerve

A

ape hand
loss of thenar muscle group - opposition abduction, flexion of thumb
no loss of sensation

76
Q

sensory distribution of recurrent medial nerve

A

none

77
Q

proximal median nerve damage

A

loss of sensation!! not with distal…

78
Q

proximal ulnar nerve damage

A

radial deviation fo wrist upon felxsion

79
Q

order of sections of hte brachial plexus

A 
randy travis drinks cold beer
roots
trunks
divisions
cords
branches
80
Q

randy travis drinks cold beer

A

roots - trunks - divisions - cords - beer

81
Q

lesion at upper trunk

A

c5c6

erbs palsy/waiters tip

82
Q

lesion at lower trunk

A

c8T1

claw hand/klumpke palsy

83
Q

lesion at posteroir cord

A

wrist drop

84
Q

lesion fo axiallary nerve

A

deltoid paralsysi

85
Q

lesion at radial nerve

A

saturday night palsy

86
Q

lesion at mc nerve

A

difficulty flexing elbow, varibale sensory loss

87
Q

lesion at media nerve

A

decrease thumb functio and popes blessign

88
Q

lesion at unlar nerve

A

intrinsic muscles of hand

claw hand

89
Q

list the trunks

A

upper - middle -lower

90
Q

list the cords

A

lateral - posterior - medial

91
Q

waht nerves come off the posterior cord

A

axiallary and radial

the extensors

92
Q

what nerves come off the lateral cord

A

musculcutaneous
and gives to the median nerve
the extensors

93
Q

what nerves come off the medial cord

A

ulnar
and gives to medial nerve
the extensors

94
Q

list the order of each segmetn of the branchial plexus

A

randy travis drinsk cold beers

roots - trunks- divisions - cords - branches

95
Q

erbs palsy causes

A

upper trunk traction ro tear

C5C6 roots

96
Q

erbs palsy muscles lost

A

axiallary, MC, suprascapular
no deltoid and supraspinatus: abduction lost = arm hands at side
no infraspinatus = no lateral rotation, arm will be medially rotated
no biceps brachia = bo flexion, arm will be extended

97
Q

trauma that occurs to cause erbs palsy

A

infants - lateral traction on neck in delivery

adults - traummaa

98
Q

what causes klumpke palsy

A

traction or tear of lower trunk

C8T1

99
Q

what causes klumpke palsy

A

infants = upward force on arm during delivery

adults - trauma (trying to catch self on branch fallign out of tree)

100
Q

what muscels are los in klumpke palsy

A

loss of ulnar nerve - intrinsic hand muscles, lumbricals, interossei, thenar and hypthenar

101
Q

how does klumpke palsy present

A

total calwa hand
lumbicla normally flex MCP joints and extend DIP and PIP joints
so in totaly claw hand get extension of MPC and flexion fo DIP and PIP

102
Q

what causes throacic outlet syndrome

A

crevical rib
pancoast tumor
spastic anterior sclaene muscles

103
Q

what part of brachial plexus compressed in thoracic otulet syndrome

A

lower trunk AND subclavina vessles **look for vascular symptoms in presentaiton

104
Q

what muscles are lost in thoracic outlet syndrome

A

intrinsic muscles of hand: lumbricals, interossei, thenar, hypthenar

105
Q

how does trhoacic outlet sydnroem rpesent

A

***vascular symptoms = atrophy of intrinsic hand muscles, ischaemia, pain, oedema

106
Q

what is damaged in winged scapula

A

long thoracic nerve

roots fo c5678t1

107
Q

what causes windged scapula

A

axiallary node dissection after mastectomy

stb wounds

108
Q

what msucels is lost in winged scapula

A

serratus anterior

109
Q

how does winged scapula present

A

inability to anchor scapular to thoracic cage

110
Q

old lady cant lift arm above horizontal position to get stuff from cupoboard

A 
dr curry
first term
long thoaric
winged scapula
cant hold sacpula to thoarcic cage
cant abduct arm above horizontal position - serartus anterior n=requried to rotate scapula to move arm up
111
Q

describe the actions of hte hand muscles at rest

A

balance between teh extrinsic fexors and etensors of the hand and the intrinsic muscles of the hand

112
Q

who wins at rest in the hands

A

lumbricals -extend mcp and flex dip and pip

113
Q

when is ‘‘clawign’’ most prominent?

A

distal lesions of ulnar and median nerves

114
Q

what happens when the lumbricals are lost

A

the other extrinsic flexors of the digiets exagerate the loss = lmubrical normally extend the mcp and flex the dip and pip == so will see flexion of mcp and extension of dip and pip

115
Q

describe when the ulnar claw presents

A

failure to extend fingers with nerve damage

116
Q

proximal or distal lesions cause ‘‘clawing’’

A

distal lesions

117
Q

what muscles fail in clawing

A

lumbricals from distal lesions @ extension

pope and ok at flexion

118
Q

describe when popes blessing occurs

A

failure to mak a fist with fingers with nerve damage

119
Q

proximal or distal lesions cause ‘‘benedicte’’

A

proximal cause benedicted - failrure to flex

120
Q

name the nerve damage:
when asked to flex the hand
fourth and fifth flex
secnod and third do not

A

failure of flexion
= proximal lesion
@ second and third = median nerve
benedicte

121
Q

name the nerve damage:
when asked to flex the hand
fourth and fifth do not flex
second and third flex

A

failure of flexion
= proximal lesion
@ foruth and fifty = ulnar nerve
ok gesture

122
Q

name the nerve damage:
when asked to extend fingers
second and third extend
fourth and fifth do not

A

failure of extension
= distal lesion
@ fourth and fifth = median nerve
median clawing

123
Q

name the nerve damage
when asked to extend fingers
second and third do not extend
foruth and fith extend

A

extension = clawing and distal

secnd and third = ulnar

124
Q

list the thenar muscles

A 
opponens poliicis
abductor pollicis brecis
flexor pollicis brecis
superfial head (deep head by ulnar nerve)
MEDIAN NERVE (recurrent)
125
Q

list the hypothenar muscles

A

opponens digiti minimi
abductor digiti minimi
flexor digiti minimi brevis
ULNAR NERVE

126
Q

what abducts the fingers

A

DAB - dorsal interossei

ULNAR NERVE

127
Q

what adducts the fingers

A

PAD - palmar interossei

ULNAR NERVE

128
Q

what do the lumbricals do

A

extend the dip and pip
arise from tendon of flexor digitorum profundus
two and three - MEDIAN NERVE
four and five - ULNAR NERVE

msk and ct - step (6 decks)

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