Anatomy PathologiesUpper extremity Flashcards
Dislocated epiphysis of femoral head that occurs in children 10-17 years old can result in what change to the angle of inclination?
Angle of inclination reduces to about 90 degrees, this is called coxa vara
Radiology to confirm dx
Which arteries can cause bleeding and femoral head necrosis
Injury to the retinacular arteries
Bone graft using the fibula utilizes what area of the fibula?
middle third where the nutrient foramen is
what tarsal most likely to fracture?
5th
Varicose Veins, Thrombosis, Thromboplebitis all cause due to a failure of valves in the perforating vines that are tributaries from the ———— vein.
great saphenous vein
winged scapula
can’t comb hair
long thoracic injury
serratus anterior not working
What nerve can be injured during surgery in the shoulder/axilla that leads to the pt not being able to do pull ups or climb or use crutches?
Thoracodorsal Nerve that innverates the lats
injury to the dorsal scapular nerve would affect the
Levator SCapulae
Loss of sensation on the lateral side of the proximal arm skin could be caused by a shoulder joint dislocation, humeral surgical neck fracture, intramuscular injection of medication. You should definitely test what muscle function?
Deltoid
Triangular and quadrangular space formed by the teres major and long head of the triceps. what exits the triangular space and what exits the quadrangular space?
Traingular space contains: circumflex scapular artery
Quadrangular Space:
- Posterior circumflex humeral artery
- Axillary Nerve
How would you test for a rotator cuff injury?
ask patient to lower arms (Adduct from 90degrees)
Why is the supraspinatus the most injured rotator cuff muscle?
It is limited by the acromion and so gets torn and inflamed
Pain during abduction (50degrees to 130 degrees) is referred to as
Painful arc syndrome
Painful arc syndrome is a result of
Subacromia bursitis and calcification
What bursa is affected in Painful arc syndrome?
The bursa that sits between the tendon of the supraspinatus and the acromion, coracoacromial ligament, and deltoid.
If the axillary vein were blocked, what collateral venous route could be affected?
Thoracoepigastric Vein
What Axillary lymph node is the first to be enlarged usually as result from infection or cancer of the shoulder and thoracic region
The Humeral Group
The cephalic vein is obstructed by a lymph node. Which one most likely?
Apical axillary lymph node
A surgeon completes an axillary lymph node dissection. Which two muscles are at risk because of the nerves that run through the axilla?
The serratus anterior (Long thoracic)
the Latissimus dorsi (Thoracodorsal nerve)
The Dorsal scapular nerve is injured. You are no longer able to
elevate the scapula because the levator scapulae and rhomboids are innervated by the dorsal scapular nerve
A swimmer hypertrophies the middle and posterior scalene muscles and all of a sudden isn’t able to comb her hair because
The serratus anterior is innervated by the long thoracic nerve which
rotates inferior angle of the scapula (punching/reaching forward)
-holds scapula against thoracic wall
The axillary nerve has been damaged when an elderly woman FOOSHd. Even though the arm is stable, what part of the humerus is likely affected?
Surgical neck. Pt probably lost sensation to lateral aspect of the upper arm. can’t abduct past 15 degrees
You can’t feel the skin on the lateral side of dorsum of the hand and the lateal 3 and a half fingers. What nerve is likely affected?
Superficial branch of the Radial nerve
You can’t extend your wrist
(deep branch of the) Radial nerve issue
The proximal posterior aspect of your arm is compressed after sleeping on a table all night. What could this result in
Saturday Night Palsy
What area of the humerus would put the radial nerve and deep arm vessels at risk if fractured?
The Radial groove (mid humeral fracture)
The distal end of the humerus if fractured could result in injury that would affect a patient’s ability to
abduct the thumb, flex the first 2 fingers. Because this would affect the median nerve that crosses lateral to the median epicondyle
The medial epicondyle is fractured. The patient can’t flex his 5th and part of his 4th fingers. What nerve injury is responsible for this?
ulnar
Shoulder dystocia or falling on the head and neck can cause injury to what cervical level leading to Erb’s Palsy
C5, C6 (Erb’s Palsy)
What muscles are paralyzed in Erb’s palsy?
Deltoid, Biceps, Brachialis, brachioradialis
this leads to waiters tip
Klumpke’s palsy is injury to what part of the brachial plexus?
The inferior part: C8, T1 possibly from sudden pull of the arm like grabbing a tree branch of grabbing arm during delivery of baby
In Backpacker’s palsy, microinjuries to the superior trunk of the brachial plexus can lead to sensory deficits in the distribution of the what 2 nerves
Musculocutaneous and Radial nerve
A man paints his ceiling and experiences pain running down his arm numbness and tingling. What aspect of the brachial plexus is affected?
superior part
You want to operate on someone’s upper limb without using general anesthesis. What plexus would you try to anesthetize and where would you inject?
anesthetize the angle between the posterior border of the sternocleidomastoid and the clavicle. It has to go into the axillary sheath containing the cords not into the vessels.
a pt presents with crepitus in the shoulder, she is a softball pitcher and also plays racquetball. The shoulder is tender and has similar pain levels with active and passive movement. What is the insertion, innervation and origin of the presenting tendinitis of this muscle
She has biceps tendinitis which affects the long head of the biceps originates at the supraglenoid tubercle of the scapula and inserts on the radial tuberosity and bicipital aponeurosis. The tendon is in a synovial sheath that travels through the intertubercular groove and can sustain microtrauma from repeated actions like throwing
Dislocation of the long head of the biceps is associated with what other injury 70% of the time
Rotator cuff injuries
If the tendon of the long of the biceps ruptures, where does the detached muscle belly go?
It’s pulled distally— popeye deformity
A kid is playing football and is hit and his arm is fucked up. What’s ikely ∂islocated?
the proximal humeral epiphysis
blood pressure cuff blocks circulation in what artery?
The Brachial Artery
What muscles would be affected with occlusion or laceration of the brachial artery?
Forearm flexor muscles affected from the ischemia.
Where would you apply pressure to stop bleeding if someone’s forearm were lacerated?
middle of the arm before the deep artery of the arm branches out.
What nerve pierces the coracobrachialis and if injured from a weapon would result in weakened forearm flexion and supination and loss of sensation on the lateral surface of the forearm?
Musculocutaneous nerve
someone can’t feel the dorsum of the hand and digits. They also can’t extend their elbow or supinate their arm or extend thei MCPs. What nerve injury?
Radial nerve injury
wrist-drop sign is when
someone has sustained a radial nerve injury and they are unable to extend the MCP joints because the extensor muscles are innervated by the deep branch of the radian nerve
What nerve can compress the median nerve and lead to pain and tenderness in the proximal anterior forearm?
Median Nerve.
In pronator syndrome the median nerve can be compressed by the heads of the pronator teres muscles.
If someone has pronator syndrome which involves median nerve compression, what will happen when they try to form a fist?
the patient can’t flex the PIPs of 1-3 and can’t flex the tips of 2 and 3
Pope’s benediction
flexor carpi ulnaris compressed what nerve within the cubital tunnel?
Ulnar Nerve presenting with a claw hand
wrist is drawn lateral when making a fist
Fracture of the the medial epicondyle puts what nerve at risk?
Ulnar nerve injury
Injury to guyon’s canal affects what nerve that travels between the flexor carpi ulnaris and the Flexor digitorum profundus
ulnar nerve
If you can’t feel the skin of your posterior forearm, what branch of the radial nerve may be affected?
Posterior Cutaneous Nerve
What does the deep branch of the radial nerve turn into?
the posterior interosseous nerve
Tennis elbow can be from inflammation of the periosteum of the lateral epicondyle of the humerus. what muscles insert here?
extensor carpi radialis brevis
extensor digitorum
extensor digiti minimi
extensor carpi ulnaris
also supinator
tennis elbow hurts when?
at rest or opening a door or lifting a glass
Golfer’s elbow affects which muscles?
PFPF
medial epicondylitis
what branch of the radial nerve would cause wrist drop and what branch would cause anesthesia of the dorsal hand?
Deep branch injury: can’t extend the MCPs
Superficial Branch Injury: can’t feel the back of hand
You look at the palm of someone’s hand and it shows progressive shortening, thickening, and fibrosis of the palmar fascia and aponeurosis. Which fingers are mainly perma-flexed
The 4th and 5th are pulled in partial flexion
Someone punctures their common synovial sheath of the flexors, what digit is in communication with that synovial sheath that the infection could spread to?
The 5th digit. This is tenosynovitis
A patient experiences radiating pain when they adduct their thumb and adduct their wrist joint. The synovial sheath of what tendons have likely undergone fibrous thickening?
Abductor Pollicis Longus
Extensor Pollicis brevis
Fibrous thickening of the synovial sheath of the Abductor pollicis longus and the extensor pollicis brevis is called?
De Quervain’s Tenovaginitis
Fibrous thickening of the Flexor digitorum superficialism and flexor digitorum profundus tendons could cause a snapping sound on passive extension known as
Digital Tenovaginitis Stenosans (trigger finger)
What sort of injections could you try before surgical intervention of trigger finger?
Steroid injections
If the palmar arterial arches are lacerated, why might there be profuse bleeding?
extensive anastamoses. stop bleeding at brachial artery
thenar muscle weakness and atrophy seen in
carpal tunnel syndrome
difficulty opposing thumb
carpal tunnel syndrome possibly
trauma to median nerve could affect the ability of the thumb to flex and abduct
carpal tunnel
Cyclist’s palsy involved ulnar nerve damage in what area?
the hand
The superior gluteal nerve on the right side is injured. What side of the hip will drop?
the left side.
sciatic nerve can be injured by
compression (hypertrophy of the piriformis)
Sciatica (irritation and inflammation due to chronic pressure
Does the sternoclavicular joint break very often?
no it’s super tough
shoulder separation vs dislocation
separation: AC joint dislocation + coracoclavicular ligament borken
dislocation: humeral head dislocated from glenoid cavity
AC joint dislocation can happen from?
FOOSH
what part of the glenohumeral joint is most weak and a point for joint dislocation?
inferior glenohumeral joint
If you aren’t able to flex your shoulder which muscles are affected (4)
Pec Major
Deltoid
Coracobrachialis
Biceps Brachii
If you can’t extend your shoulder which muscles affected? (2)
Latissimus
Deltoid
Shoulder abduction controlled by (?)
Supraspinatus to 15 degrees
Deltoid after that
Shoulder Adduction controlled by
Pec Major
Latissimus Dorsi
Rotator Cuff muscles
Shoulder Medial Rotators controlled by (3)
Subscapularis
Teres Major
Latissimus Dorsi
Shoulder lateral Rotators
Infraspinatus and Teres Minor
Resist downaward dislocation of the joint
Coracobrachialis
Biceps
Long head of the triceps
Deltoid
what tendon is affected in painful arc syndrome?
Supraspinatus tendon
there is also inflammation of the subacromial bursa
Frozen shoulder is from fibrosis that occurs as a result of what injuries?
Painful arc
Partial Tearing of rotator cuff
Bicipital tendonitis
What is the most common shoulder dislocation?
anterior dislocaiton from a hard blow when shoulder is abducted
What nerve can be affected by glenohumeral joint dislocation?
Axillary nerve
Glenoid Labrum tears happen to what sort of athlete?
pitchers/ baseball throwers
You are flexing your elbow what main muscles are you using?
Brachialis, biceps brachii, brachioradialis
You are extending your elbow what muscles are you using
Triceps
What bursa in the olecranon can become inflamed due to repeated pressure or friction? This is known as Student’s elbow
Subcutaneous olecranon bursa
Elbow dislocation can affect what nerve?
Ulnar Nerve
Nursemaid’s elbow a dislocation from what ligament
Annular ligament
colles fracture
distal 2cm radial fracture
Anterior dislocation of the lunate
happens to dorsiflexed wrist, lunate is dislocated into the carpal tunnel or the palm pressing the median nerve
Fracture-dislocation of the distal radial epiphysis
happens to children, radial epiphysis is displaced dorsally
gamekeeper’s thumb
thumb sprain from a torn collateral ligament
Mallet finger
distal extensor tendon rupture from evulsio of extensor tendon
Jersey finger
distal flexor tendon rupture from ruptured flexor digitorum profundus tendon from attachment on the distal phalanx
Boutonniere deformity
extensor slip rupture of the central tendinous slip of the extensor hood
