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Anatomy > Back + Upper Limb Clinical Correlates > Flashcards

Back + Upper Limb Clinical Correlates Flashcards

1
Q

T/F the spinal cord segment that gives rise to a single spinal nerve does not always lie adjacent to the corresponding vertebral level:

A

TRUE

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2
Q

What space is CSF obtained in a lumbar puncture?

A

subarachnoid space

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3
Q

In adults, where is a lumbar puncture performed?

A

L3/L4 or L4/L5

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4
Q

Risk of injury is decreased during a lumbar puncture below what vertebral level?

A

below L2

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5
Q

How do you localize the L4 level for a lumbar puncture?

A

palpate the iliac crests and move to the midline

have pt flex forward in a sitting or side lying position

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6
Q

Where is the needle inserted during a lumbar puncture to obtain a CSF sample?

A

through the supraspinous ligament and into the lumbar cistern

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7
Q

What is another name for spinal anesthesia?

A

nerve block

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8
Q

Spinal anesthesia is administered into the epidural space similar to a lumbar puncture, what does this cause?

A

loss of sensation inferior to the level of administration

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9
Q

To affect sacral spinal nerves, where do you inject spinal anesthesia?

A

inject via sacral canal or posterior sacral foramina

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10
Q

How does whiplash occur?

A

occurs with severe hyperextension of the neck

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11
Q

What does whiplash damage?

A

damages paravertebral neck musculature and ligaments (anterior longitudinal)

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12
Q

What is the mechanism of injury for whiplash?

A
  • force applied posteriorly (rear-end motor vehicle accident)
  • head is forced posteriorly (head-on football tackle, physical abuse)

causes neck to hyperextend

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13
Q

Severe whiplash may also involve what?

A

anterior widening of intervertebral space at level of vertebral body as a result of disc tearing

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14
Q

Rupture of the transverse ligament of the atlas can cause what?

A

partial dislocation (subluxation) or complete dislocation of atlantoaxial joint

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15
Q

Complete dislocation of the atlantoaxial joint may result in what?

A

upper cervical spinal cord injury
(the dens may impinge posteriorly on cord or superiorly on brainstem)

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16
Q

A severe upper cervical spinal cord injury can cause what?

A

quadriplegia, while brainstem injury can be fatal

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17
Q

What is the most common health complaint?

A

lower back pain

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18
Q

What are some sources of lower back pain?

A
  • fibroskeletal (sprain), meningeal, synovial, muscular (strain), and nervous tissues
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19
Q

What are some common causes of lower back pain?

A
  • degenerative disc changes
  • poor posture
  • improper lifting technique
  • abdominal muscle weakness/imbalance
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20
Q

Sprains in the spine involve what?

A

ligament damage or damage at the osseoligament interface

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21
Q

Pain associated with sprains in the spine can be reproduced how?

A

with end of range movements of the vertebral column

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22
Q

Strains involve what?

A

overstretching or microtearing of back muscle fibers

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23
Q

Strains in the spine most often occur where?

A

lumbar region, especially in postural muscles of erector spinae

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24
Q

Pain associated with strains in the spine is often caused by what?

A

inflammation and subsequent muscle spasms, especially with movement

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25
Q

Spasms can lead to a physiologic muscle-holding pattern, which may cause what?

A

spinal malalignment and increased pain

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26
Q

Most cases of low back pain are caused by what?

A

muscle strain

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27
Q

Deviation from the normal primary and secondary spinal curvatures can cause what?

A

functional impairments

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28
Q

What excessive thoracic curvature appears more convex posteriorly and often occurs in the geriatric population as a result of degenerative changes in the spine and poor posture?

A

kyphosis

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29
Q

What excessive lumbar curvature appears more concave posteriorly and is associated with an anteriorly rotated pelvis and accompanying shortening of hip flexor muscles?

A

lordosis

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30
Q

What abnormal lateral curvature of the spine involves both lateral bending and rotation of the spine, creating a lateral concavity?

A

scoliosis

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31
Q

What curvature is often seen in adolescent girls and causes can be either postural/positional or congenital?

A

scoliosis

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32
Q

Spondylosis is the degeneration of what?

A

vertebral column

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33
Q

What region does spondylosis most often occur?

A

cervical region

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34
Q

What is most vulnerable to degenerative changes, leading to narrowing of disc space/weakening of annulus fibrosis, and bone spur formation?

A

Vertebral discs and facet

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35
Q

Degenerative changes can also affect the which ligament, which increases the risk of spinal cord compression as a result of disc herniation?

A

adjacent posterior longitudinal ligament

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36
Q

What symptoms are a common drive for patients to seek medical attention?

A

myelopathy and radiculopahty

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37
Q

Tears in the what can lead to herniation or protrusion of the gelatinous inner nucleus pulposus into the vertebral canal

A

outer annulus fibrosus

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38
Q

Why does herniation most often occurs in a posterior or posterolateral direction?

A

because the posterior longitudinal ligament is weaker and narrower than its anterior counterpart

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39
Q

_____ herniation in the posterior direction can impinge on the spinal cord, whereas the more common ______ herniation impinges on spinal nerve roots.

A

disc; posterolateral

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40
Q

Disc herniation symptoms include what?

A

muscle weakness, and reflex changes

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41
Q

A herniation affecting the spinal nerve root at the level below L3/L4 would affect what spinal nerve root?

A

L4 spinal nerve root

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42
Q

What decreases with age?

A

disc health (structural integrity of intervertebral disc)

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43
Q

What changes decreases the mobility of the disc and increase risk of injury?

A

Disc dehydration with changes in nucleus pulposus

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44
Q

What is a laminectomy?

A

a surgical procedure that involves removal of a spinous process and associated laminae and pedicles at one or more vertebral levels

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45
Q

Why would a laminectomy be performed?

A

to create more space in the vertebral canal, relieving pressure on the spinal cord and spinal nerve roots

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46
Q

Pressure in the spinal cord is often caused by what?

A

spinal stenosis (narrowing of the canal) as a result of a space-occupying lesion, such as excess bony growth, tumor formation, or disc herniation

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47
Q

Vertebral dislocation without fracture most often occurs where? Why?

A

cervical region because of the horizontal orientation of articular facets

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48
Q

Pure dislocation in the thoracic and lumbar regions is less common and occurs in conjunction with additional factors, such as what?

A

fracture, pathology, or congenital malformation

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49
Q

Some examples of dislocations with fractures are:

A
  • spondylolysis (Scottie dog fracture)
  • spondylolisthesis
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50
Q

What is spondylolysis (Scottie dog fracture)?

A

racture of the pars interarticularis is most commonly observed in young athletes at the L4 or L5 level

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51
Q

What is spondylolisthesis?

A

Anterior displacement of the vertebral body

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52
Q

Where does spondylolisthesis typically occur

A

lumbosacral junction

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53
Q

What anterior compression fracture is accompanied by a transverse fracture through posterior vertebral structures?

A

chance fracture (seat-belt injury)

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54
Q

Where does a chance fracture (seat-belt injury) most commonly occur in the pediatric population?

A

T12/L1 interface

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55
Q

What the of fracture is a burst fracture of the C1 vertebra with at least two points of fracture is often associated with headfirst diving into shallow water?

A

Jefferson fracture

56
Q

What fracture is a bilateral fracture through the vertebral arch of C2 (axis) often occurs just posterior to the articular facets when force is applied to a hyperextended neck and can result in C2 traumatic spondylolisthesis and spinal cord injury

A

Hangman fracture

57
Q

What is a hyperflexion injury in the cervical spine is characterized by the avulsion of a triangular bony fragment from the anteroinferior region of the vertebral body

A

Teardrop fracture

58
Q

Occlusion of the great anterior segmental medullary artery can eliminate blood supply to the what, causing paraplegia?

A

inferior two thirds of the spinal cord

59
Q

When does the neural plate begin to fold?

A

week 4

60
Q

What week does the neural tube close?

A

week 4

61
Q

Where does the closure of the neural tube begin?

A

occipital/cervical region

62
Q

The closure of the anterior end of the neural tube is called what?

A

anterior neuropore

63
Q

The closure of the posterior end of the neural tube is called what?

A

posterior neuropore

64
Q

If the anterior neuropore fails to close, upper neural tube defects occur. What is this called?

A

anencephaly

65
Q

If the posterior neuropore fails to close, lower neural tube defects occur. What is this called?

A

spina bifida with myeloschisis

66
Q

As the neural tube folds, some cells differentiate into what?

A

neural crest cells

67
Q

The lumen of the neural tube gives rise to the ventricular system of the _____ and _____ _____ of the spinal cord.

A

brain; central canal

68
Q

Where is blood pressure assessed at?

A

brachial artery

69
Q

Where is the artery occluded by a blood pressure cuff?

A

occluded against the humeral shaft

70
Q

Where are arterial sounds observed with a stethoscope?

A

over the brachial artery in the cubital fossa

71
Q

What is used to measure systolic and diastolic pressures?

A

sphygmomanometer

72
Q

What does the first absent sound represent in blood pressure

A

diastolic

73
Q

Brachial pulse can be felt medial to which tendon?

A

bicipital tendon

74
Q

What is normal blood pressure?

A

90–120/60–80 mm Hg

75
Q

Where are the common sites for brachial plexus nerve block?

A

supraclavicular, axillary sheath, and interscalene

76
Q

What bone is the most commonly fractured bone in the body?

A

the clavicle

77
Q

Fractures typically occur between the _____ and _____ thirds from direct trauma to the shoulder or indirect force from falling on an outstretched upper limb

A

middle; lateral

78
Q

The proximal clavicle (PC) is pulled superiorly by the _______

A

sternocleidomastoid

79
Q

while the distal clavicle (DC) is depressed inferiorly because of the weight of the ____ ____

A

upper limb

80
Q

What else is at risk in a clavicle fracture?

A

brachial plexus divisions and axillary vasculature are at risk of secondary injury

81
Q

What can be injured in a surgical neck fracture?

A

axillary nerve and circumflex humeral vessels

82
Q

What can be injured in a mid shaft fracture?

A

radial nerve and profunda brachii vessels

83
Q

What can be injured in a supracondylar ridge fracture?

A

median nerve and brachial vessels

84
Q

Fracture of the surgical neck is common in geriatric population with osteoporosis and may injure the _____ nerve and circumflex humeral vessels.

A

axillary

85
Q

Midshaft or spiral groove fractures may injure the _____ nerve and profunda brachii vessels.

A

radial

86
Q

Supraepicondylar ridge fractures may injure the _____ nerve and brachial vessels.

A

median

87
Q

Medial epicondyle fractures may injure the _____ nerve and superior ulnar collateral vessels.

A

ulnar

88
Q

What type of fracture is through the distal radius, resulting in the proximal segment moving anteriorly and the distal segment moving posteriorly, giving the distal forearm the appearance of a dinner fork.

A

Colles fracture (“dinner fork” deformity)

89
Q

What is a fracture of the fifth metacarpal (or fourth) at the junction of the distal shaft and head (neck)?

A

Boxer fracture

90
Q

What are common sites for IV placement?

A

superficial dorsal venous network and distal basilic or cephalic veins

91
Q

What vein is easily accessible for blood sampling?

A

median cubital vein

92
Q

______ occurs when lymph return from the extremities is interrupted, causing excessive swelling in the affected limb:

A

lymphedema

93
Q

Removal of axillary lymph nodes in conjunction with a _______ is a common cause for upper limb lymphedema

A

mastectomy

94
Q

Compression sleeves paired with frequent lymph massage may assist in moving the static lymph centrally and decrease _____.

A

edema

95
Q

______ is an infection deep in the hand or forearm can result in inflammation of the associated lymphatic vessels.

A

lymphangitis

96
Q

What is the first group affected because lymphatic vessels of the upper limb drain through this group before moving more centrally.

A

humeral (lateral) group

97
Q

What disease is vasoconstriction of the digital arteries of idiopathic origin?

A

Raynaud disease

98
Q

What is believed to be the cause vasoconstriction in Raynaud disease?

A

overactive postganglionic sympathetic fibers

99
Q

Cold temperatures and emotional stimuli may trigger what ischemic event?

A

Raynaud disease

100
Q

Surgical correction in the upper limb to correct Raynaud disease may include what?

A

presynaptic sympathectomy

101
Q

Name two types of brachial plexus injuries:

A
  1. upper trunk injury (Erb-Duchenne palsy)
  2. lower trunk injury (Klumpke paralysis)
102
Q

A patient presents with his or her upper limb in a “waiter’s tip” position, where the arm is adducted, extended and internally rotated, elbow extended, and forearm pronated because of the number of muscles paralyzed. What is this called?

A

upper trunk injury (Erb-Duchenne palsy)

103
Q

A patient presents with “claw hand” mainly because of the paralysis of the medial lumbricals. What is this called?

A

lower trunk injury (Klumpke paralysis)

104
Q

Lesions of the long thoracic nerve will paralyze what muscle? What will this result in?

A

paralyzes the serratus anterior muscle, resulting in a “winged” scapula

105
Q

“Winged” scapula inhibits full abduction of the affected limb is impossible because the _____ _____ is unable to assist with upward scapular rotation.

A

serratus anterior

106
Q

Which tendon is more commonly implicated in rotator cuff injuries?

A

supraspinatus tendon

107
Q

Why is the supraspinatus tendon more commonly implicated in rotator cuff injury?

A

because of the small osseoligamentous path by which it travels to insert onto the greater tubercle

108
Q

Pain associated with rotator cuff injury and bursitis is often exacerbated when patient is asked to abduct his or her arm above 50°, what is this called?

A

painful arc syndrome

109
Q

The upper limb is vulnerable to what?

A
  • tendonitis (inflammation of the tendon)
  • tenosynovitis (inflammation of tendon and synovial sheath)
110
Q

What type of injury radial nerve injury can result in full loss of elbow extension because of paralysis of the triceps brachii (proximal injury) and wrist drop or just wrist drop (at or distal to spiral groove) with elbow extension spared?

A

radial nerve injury

111
Q

The wrist drop in a radial nerve injury occurs because of what?

A

paralysis of wrist and finger extensors

112
Q

In a radial nerve injury, the deep branch of the radial nerve can also become impinged as it travels deep to what muscle?

A

supinator muscle

113
Q

What muscle can entrap the deep radial nerve and cause downstream motor/sensory impairments of deep extensor forearm muscles and joints”?

A

supinator muscle

114
Q

What type of contracture is a contracture of the medial half of the palmar deep fascia of genetic origin?

A

Dupuytren contracture

115
Q

A pt who has Dupuytren contracture will see their digits to move into a flexed position. Why does this occur?

A

bands of the palmar aponeurosis associated with the fourth and fifth digits begin to shorten and fibrose

116
Q

What digits does Dupuytren contracture involve?

A

4th and 5th digits

117
Q

Carpal tunnel syndrome involves compression of the ____ nerve in the carpal tunnel:

A

median

118
Q

Atrophy of the ____ eminence is present in carpal tunnel syndrome:

A

thenar

119
Q

Clinically, a patient with what type of lesion at the elbow presents with the inability to flex digits one through three completely (“hand of benediction”)?

A

median nerve lesion

120
Q

What two signs can present with a median nerve lesion?

A
  • “hand of benediction” (atrophy of the thenar eminence)
  • “OK” sign (unable to maintain flexion of the interphalangeal joints)
121
Q

Dislocation of the what joint occurs most often in young athletes and in the anteroinferior direction?

A

glenohumeral

122
Q

The axillary nerve and circumflex humeral vessels are vulnerable in what type of injury?

A

glenohumeral joint (shoulder) dislocation

123
Q

In a shoulder separation injury, why is the shoulder less rounded and squarer appearance?

A

the weight of the upper limb pulls it inferiorly, accentuating the point of the acromion through the lateral shoulder skin

124
Q

Dislocation of the humeroradial joint (“nursemaid’s elbow”) can occur when the ____ ligament is partially or completely torn.

A

anular ligament

125
Q

In nursemaids’ elbow, what becomes dislocated and appears as a palpable mass in the cubital fossa?

A

the radial head

126
Q

Why does the radial head become dislocated and appears as a palpable mass in the cubital fossa?

A

the biceps brachii pulls the radial head anteriorly and superiorly once dislocated

127
Q

What is the pain in nursemaid’s elbow believed to be?

A

anular ligament being pinched in the joint

128
Q

When the ulnar collateral ligament is torn—common in baseball pitchers—surgical repair involves harvesting a tendon of what muscle?

A

palmaris longus

129
Q

Ulnar collateral ligament reconstruction is also called what?

A

Tommy John surgery

130
Q

Congenital anomalies of the limbs fall into how many general categories?

A

4

131
Q

What congenital limb anomaly category does missing part of a limb or entire limb fall into?

A

1 (reduction defects)

132
Q

What congenital limb anomaly category does extra digits fall into?

A

2 (duplication defects)

133
Q

What congenital limb anomaly category does fusion of digits fall into?

A

3 (dysplasia defects)

134
Q

What congenital limb anomaly category does physical forces damage the developing limb fall into?

A

4 (deformation defects)

135
Q

Limb development occurs over a 5 week period, from week __ to week __

A

week 4 to week 8

136
Q

When does the upper limb bud?

A

day 24

137
Q

When does the lower limb bud?

A

day 28

Anatomy (3 decks)

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