Arm FINAL Flashcards
pectoral girdle
-elevation, depression, protraction (hunch), retraction
-serratus anterior- thong thoracic
-rhomboid major/minor, levator scapulae - dorsal scapular
-trapezius- accessory
-subclavius- depress
-pectoralis minor- pectoral n - protract
-scapula and clavicle
humeral fracture
-MC elderly with osteoporosis -> surgical neck and distal radius (colles)
-surgical neck -> axillary and posterior anterior humeral circumflex
-direct blow -> radial nerve, profunda brachii
-supraepicondylar- medial nerve and brachial artery
-medial epicondyle- ulnar
colles fracture
-MC forearm fracture
-forced dorsiflexion /falling on out stretched hand
-ulnar styloid is often avulsed off
-dinner fork deformity
-radius is shortened and comminuted
hamate fracture
-may damage ulnar artery/nerve
-decreased grip strength
shoulder separation
-compete tear- surgical repair -> AC and CC rupture -> just under skin
-partial- immobility heals
-stretching of ligaments
-clavicle can displace posterior over acromion
-Acromioclavicular ligament and Coracoclavicular ligament
-be careful of axillary and lateral pectoral
-if CC tears -> arm weighs down
rotator cuff
-suprascapular, infrascapular - suprascapular n
-teres minor- axillary
-subscapular (medial rotation)- subscapular nerve
-MC suprascapular tear -> problem with first 15 degrees abduction (extrinsic/wear and tear or intrinsic/blood supply decrease)
-teres minor and infraspinatus- lateral rotation
shoulder joints
-TRUE- sternoclavicular (ball and socket), glenohumeral (frozen shoulder), acromioclavicular
-FALSE- subacromial/suprahumeral, scapulothoracic
-frozen shoulder- adhesive fibrosis and scarring between glenohumeral joint, rotator cuff, subacromial bursa, and deltoid -> cant abduct past 45 degrees
flexors and extensor of shoulder
-lady and two majors
FLEXION
-pec major
-lat
-deltoid clavicular head
EXTENSION
-teres major
SLAP tear
-superior labrum anterior posterior tear
-where the bicep tendon inserts
-quick lift, fall on hand
-bicep pop and curl
shoulder dislocation, quadrangular, tricep hiatus
-MC anterior- fall on extended arm
-posterior- head of humerus behind socket -> uncommon -> severe shock, seizures
-inferior- arm pushed down and out of socket
-hillsachs fracture- humeral head fracture 2ndary to dislocation
-axillary nerve and posterior circumflex (quadrangular)
-radial nerve and profunda brachii artery (triceps hiatus)
quadrangular space syndrome
-compression of axillary nerve (C5 and C6)
-pain over posterior lateral shoulder
-sargents patch
-vascular compromise of circumflex
-MRI for teres minor atrophy
subclavian artery
-subclavian gives off superior thoracic artery -> supplies 1st rib
-becomes axillary at pec minor
-axillary gives off thoracoacromial and lateral thoracic
-at the level of surgical head gives off posterior anterior humeral circumflex and subscapular arteries
-at teres major it becomes brachial artery
-brachial gives of profundus brachii and radial and ulnar artery
-ulnar artery gives of interosseous branches
volkmans contracture
-injury to elbow or upper arm
-usually crush injury
-brachial artery damage
-acute compartment syndrome
-contracture of muscles
-permanent deformity
-flexion of fingers and wrist
-ischemia and paralysis
-supracondylar fracture most common!!
-5 Ps -> pain with passive movement, paresthesias, pallor, paralysis, pulselessness
-3 As- increase analgesics, anxiety, agitation
-stryker pressure monitor
bicep tendon
-C6/C5 reflex
arm extensors
-attach to olecranon of ulna
-triceps brachii
-anocneus
-long head -> adduction and extension of shoulder
elbow ligaments
-annular- over radial head -> fracture or subluxation of radial head -> nurse maids elbow
-tennis elbow- lateral epicondylitis pain with EXTENSION of wrist or fingers
-ulnar collateral tear- repeated pinching and twisting -> tommy john surgery (take tendon from plantaris or palmaris longus)
elbow joints
-humeroulnar joint- composite hinge joint -> flex and extend -> wrench (olecranon of ulna) and nut (trochlea of humerus)
-humeroradial joint- ball and socket- pronation and supination
-radioulnar joint- pivot joint- prevents spinning out of control (excessive pronation/supination) -> prevents nurse maid elbow dislocation
subluxation vs dislocation of elbow
-dislocation- radial and ulnar out of joint -> dislocate posteriorly
-humeral head out-> major force
-subluxation- bones out of communication
-subluxation occurs with pulling, swinging, pulling by arm (child) -> radial head splits out from under annular ligament -> decrease stability of radioulnar joint
-nurse maids
-cant bend wrist
henrys mobile wad
-extensor carpi radialis longus and brevis
-brachioradialis
-lateral epicondyle attachment
-radial nerve
elbow dimpling
-forearm appears longer
-epicondyles misplaced
-radial head displaced
-concern for ulnar nerve
ulnar nerve injury
-ulnar claw hand
-cant extend the 4th and 5th fingers
-flexor digitorum profundus and superficialis take over -> excessive flexion
-ulnar canal syndrome- hypothesias on medial hand
-froments sign- loss of adductor pollicis -> flexors take over -> pulling paper out of pts hand and they compensate with thumb flexion
scaphoid fracture
-point tenderness
-fall on outstretched hand
-lateral hand pain
-avascular necrosis may occur
-degenerative joint disease of wrist
-cant see on image at first
falling on outstretched hand
-anterior shoulder dislocation
-surgical neck or supraepicondylar fracture
-colles fracture
-scaphoid fracture
-SLAP tear
-clavicular fracture
-CONCERN
-axillary nerve, lateral pectoral nerve
-posterior and anterior humeral circumflex artery
-subscapular
hand bones
-scaphoid
-lunate
-triquetrum
-pisiform
-trapzium
-trapezoid
-capitate
-hamate
Thenar Muscles
-Median Nerve
-fine movements of the thumb (lateral)
-opposition abduction flexion at thumb
All- Abductor Pollicus Brevis
For- Flexor Pollicus Brevis
One- Oppones Pollicus
And- Adductor Pollicus- ULNAR NERVE
hypothenar
-ulnar nerve
-opposition and flexion at pinky
-One- Oppones Digiti Minimi
For- Flexor digiti minimi
All- Abductor digiti minimi
lumbricals
-attach to flexor digitorum profundus
-flex at metacarpal phalanges joint -> makes L
interossei- intrinsic hand muscle
-2 types
-palmar aspect/dorsal aspect
-DAB- dorsal ABduct
-PAD- palmar ADduct
-ULNAR NERVE
median nerve innervation in hand
-LOAF
-abductor pollicis brevis
-opponens pollicis
-flexor pollicis brevis
-lumbricals (1st and 2nd)
median nerve injury
-cant make a first
-ROCK
-flexor digitorum superficialis
-flexor carpi radialis
-palmaris longus
-flexor pollicis longus
radial nerve injury- hand
-cant do paper
-extension
-flexor carpi radialis longus and brevis
-brachioradialis
ulnar nerve injury- hand
-cant perform scissors
-abduction and adduction of palmar and dorsal interossei
anterior triangle
-superior border- mandible
-medial- midline
-lateral- anterior border of SCM
-suprahyoid and infrahyoid muscles
-submandibular- between the digastric bellies -> submandibular gland, fascial artery and vein
-submental- hyoid is base -> anterior jugular
-carotid triangle- omohyoid (anterior), SCM, posterior digastric -> common carotid, internal jugular, vagus, glossopharyngeal
-muscular triangle- SCM, midline, anterior omohyoid -> omohyoid, sternohyoid, sternothyroid, thyrohyoid
infrahyoid muscles
-work on hyoid bone for respiration and swallowing
-omohyoid- ansa cervicalis (C1, C2, C3)
-sternohyoid- ansa cervicalis
-sternothyroid- ansa cervicalis
-thyrohyoid- thyrohyoid branch of hypoglossal nerve
suprahyoid muscles
-digastric (posterior belly)- facial n
-digastric (anterior belly)- nerve to mylohyoid
-mylohyoid- nerve to mylohyoid
-geniohyoid- C1 via hypoglossal n
-stylohyoid- facial n
-elevated hyoid
posterior triangle of neck
-supraclavicular/subclavian- omohyoid (posterior), SCM, clavicle -> subclavian artery and vein, external jugular vein
-occipital- omohyoid (posterior), SCM, trap -> spinal accessory nerve, brachial plexus, scalenes, occipital lymph nodes
superficial fascia of neck
-platysma
-contains infections
-once gets through it spreads rapidly
retropharyngeal space of neck
-between pre tracheal and pre vertebral fascia
-T1-T2
-anterior- pre tracheal encloses trachea, thyroid, esophagus
-posterior- prevertebral fascia around vertebral column, scalenes, prevertebral muscles
-lateral- carotid sheath
-infection can seep deeper to superior mediastinum
-danger space- continuous with mediastinum and up until diaphragm -> posterior mediastinum infection spread
ludwigs angina
-med emergency
-infection spread to retropharyngeal space
-infected dentition
-compromise airway
-immunocompromise adults / child
-area swells quick
-red neck
-dysphagia
-hot potato voice
external jugular vein
-internal barometer
-venous pressure
-normally visible superior to clavicle
-distention -> heart failure, obstruction of vena cava, lymph node compression, increased intrathoracic pressure
left supraclavicular node
-virchows node- left
-thoracic duct empties all lymph here
-enlarged -> high suspicious on abdominal cancer
-right side - right lymphatic duct -> right arm, right breast, right neck
-thoracic duct connects to subclavian vein -> if virchow node is large enough -> compression of nerves and vessels
carotid
-in carotid sheath
-common carotid -> internal and external carotid
-internal- continues up into cranium before it branches
-right after internal and external split -> carotid sinus
-carotid sinus- specialized sensory cells- baroreceptors that detect stretch (BP) -> receives nerve impulses from glossopharyngeal -> Regulates BP
-slows heart and BP
-hypersensitive to any pressure -> can cause -> syncope
-between external and internal cluster of nerve cells -> carotid bodies -> chemoreceptor -> detect O2 in blood -> relay to brain -> control breathing rate
External carotid artery branches
-Some Attending’s Like Freaking Out Potential Medical Students
-no internal carotid artery branches until up into neck
-superior thyroid artery- almost right after bifurcation
-ascending pharyngeal artery
-lingual artery
-facial artery
-occipital artery
-posterior auricular artery
-maxillary artery
-superficial temporal artery
subclavian vein
-internal jugular vein branches
-thoracic duct drain in
-virchow node can compress in enlarged
superior vena cava syndrome
-tumor pressing on superior vena cava
-prevents draining
-dilated veins in neck -> external jugular
-obstructed collateral veins -> chest
-cant drain blood from face -> flushing
-pembertons sign- put hands up facial plethera -> increase erythema on face
-lymphoma, lung cancer
thyroid gland
-below larynx
-wraps around trachea
-isthmus connects
-thyroglossal duct cyst- patent thyroglossal duct -> cyst develops
-anterior mass
-pyramidal lobe of thyroid +
-tracheotomy- BELOW cricothyroid, tube in 2nd tracheal space usually not emergency usually after dividing thyroid isthmus
-cricothyroidotomy- ABOVE cricothyroid, emergency, tube through cricothyroid membrane
cervical plexus
-C1 gives rise to nerves that innervates glenohyoid and thyrohyoid muscles -> travel with hypoglossal
-ansa cervicalis- loop of nerves -> roots C1-C3 -> 4 branches - innervate superior/inferior belly of omohyoid, sternohyoid, sternothyroid
-medius scalane C3-C4*
-indirect innervation for the rest of scalenes from cervical plexus
RTDCB
-roots- C5-T1- by scalenes
-trunks- superior, middle, inferior (past scalenes)
-divisions (under clavicle)- anterior and 3 posterior
-cords (axilla)- lateral, posterior, medial
-terminal branches (arm)- muscuocutaneous, axillary, radius, median, ulnar
erbs palsy
-C5, C6 injury
-stretching injury
-fall on neck, lateral stretch of neck
-pulling on baby head during delivery
-musculocutaneous, axillary, suprascapular end nerves to subclavius
-supraspinatus, infraspinatus, subclavius, biceps, brachialis, deltoid, teres minor are affected
-sensation affected on lateral aspect of upper limb- C5-C6 dermatome
-arm hangs limp, medially rotated at shoulder
-cant flex at elbow
-unopposed action of pec major
-supraspinous isnt pulling it back
-forearm pronated due to loss of biceps brachi
-wrist flexed -> normal tone of wrist flexors (extensions weakened)
-waiters tip deformity- pronation, forearm extension, wrist flexed
-suprascapular nerve -> supraspinatus, infraspinatus -> unable to keep lateral rotation of shoulder
-musculocutaneous nerve -> unable to flex biceps, brachioradialis flexion at elbow and supination
-axillary nerve -> motor deltoid and teres mINOR -> able to abduct arm
-some branches to posterior cord- radial nerve -> forearm extensors
klumpke’s palsy
-less common
-C8-T1
-reaching up
-limb presentation during delivery -> stretch injury of axilla
-injury to T1 (ulnar and median)
-intrinsic hand muscle injury
-medial side of upper limb sensation- C8-T1 dermatome
-loss of motion and/or sensation in wrist and hand -> cant move fingers
-claw hand
-lumbricals- flex metacarpals and extend interphalangeal joints -> paralysis -> extended metacarpals and flexed interphalangeal
thoracic outlet syndrome
-overuse, compression of brachial plexus
-collar bone, first rib compression
-pain, numbness
-20-40 yo- repetitive physical activity or heavy lifting
-1. neurogenic- nerve roots or any part of brachial plexus -> 3 areas of concern
-scalene triangle- posterior and medius scalene
-costoclavicular junction- cords
-interpectoral space- branches or divisions
- 2. vascular impingement - compression of subclavian artery or vein
-gamer posture
gamer posture
-thoracic outlet syndrome
-hypertonic or spasm from poor posture
-unconscious contraction of pec muscles (not stretched)
-leaning head forward- scalenes unconscious contracted
-weakening of posture muscles- lower trap, serratus anterior, flexor muscles at neck
-numbness and weakness
dermatomes of face
-C2- posterior scalp- superior to ear
-C2,C3- anterior ear, posterior ear, back of head, anterior top half of neck
-C3, C4- neck, chest, shoulder
