Block 3: Limb Review Flashcards
Biceps tendon reflex
C5, C6 (mainly C6)
Triceps tendon reflex
C6, C7 (mainly C7)
Patellar tendon reflex
L2, L3, L4
Achilles tendon reflex
S1, S2
Where is the quadrangular space? What passes through the quadrangular Space
gap in the posterior wall of the axilla
s(x)’s: axillary nerve, posterior circumflex humeral artery
Fracture of the surgical neck of the humerus affects what nerve
axillary nerve
Function of the deltoid muscle?
abduction
Function of the teres minor muscle?
external rotation
What is the sensory distribution for the axillary nerve?
posterolateral shoulder
What contributes to abduction greater than 90 degrees?
serratus anterior
trapezius
List the rotator cuff muscles
supraspinatus
infraspinatus
teres minor
subscapularis
How do you injury the axillary nerve?
- fracture of the surgical neck of the humerus
- quadrangular space compression
- shoulder dislocation
When does the long thoracic nerve get injured
during mastectomies
Medial winging of the scapula
caused by long thoracic nerve injury; can no longer anchor down the medial border to the thoracic cage
Radial nerve innervates (motor/sensory)
motor: posterior compartment of the arm and forearm
sensory: dorsum of the arm, forehand, hand
What is the path of the radial nerve?
travels around the humerus in the radial groove
crosses anterior to the lateral epicondyle
Describe the split of the radial nerve
splits into the deep branch (motor) and superficial branch (sensory)
Describe the course of the deep branch of the radial nerve
pierces the supinator and continues as the posterior interosseous nerve
What causes wrist drop?
damage to the radial nerve
What does the ulnar nerve innervate
anterior compartment of the forearm
hand (not thenar)
sensory (medial hand–palmar & dorsal), pinky and half of ring finger
What is the terminal branch of the medial cord?
ulnar nerve
Determine the route of the ulnar nerve
passes posterior to the medial epicondyle of the humerus, gives off sensory branch to dorsal palm, passes through gunyon/ulnar canal in wrist
What is the ulnar surrounded by in the wrist?
pisiform and hamate
Fracture of the hook of hamate
leads to ulnar nerve compression
Median Nerve Innervation
forearm: all except FCU & 1/2 FDP
hand: 1st 2 lumbricals, thenar muslecs
sensory: palmar aspect of lateral hand, tips of innervated fingers
What is the result of a supracondylar fracture of the humreus?
injures the median nerve
Describe the route of the median nerve
crosses medial to the biceps brachii tendon & artery
passes b/w head of the pronator teres
splits to median nerve proper & AIN
Recurrent branch of the median nerve injury
easy to injure b/c it is superficial
What are the contents of the carpal tunnel?
1 Median Nerve 9 Tendons (4 of FDP/FDS; 1 FPL)
Tinel’s test
tap the carpal tunnel to innervate the nerve
Pronator Teres Syndrome
median nerve compression b/w the pronator teres heads
What does the musculocutaneous nerve pierce?
pierces the coracobrachialis
Sensory of the musculocutaneous nerve
lateral forearm
Where does the suprascapular nerve travel?
under the transverse scapular ligament
How to injure the suprascapular nerve
compression under the transverse scapular ligament
compression around the greater scapular notch
List the courses for the cephalic and basilic vein
cephalic: lateral, originates @ anatomic snuffbox
basilic: medial
Median Cubital Vein
goes across the bicipital aponeurosis
Greater saphenous vein
medial
List the femoral triangle
NAVL
Nerve, artery, vein, lymphatics (lateral to medial)
contents of the cubital fossa (lateral to medial)
biceps brachii, brachial artery, median nerve
Coracoclavicular ligament
provides superior-inferior stability of the shoulder joint
Acromioclavicular ligament
provides AP stability of the shoulder joint
What is the most common shoulder dislocation
anterior most common
posterior due to seizure or electrocution
Compartment Syndrome
high pressure in tight fascia leads to no blood flow and an emergency fasciotomy is needed
Volkmann’s Contracture
ischemia, flexor muscles die, fibrosis
FOOSH is associated with
supracondylar fracture
colles’ fracture
scaphoid
Colles’ Fracture
dorsal displacement of the distal fragment of the radius
What’s the most commonly broken hand bone? Issue?
scaphoid bone; avascular necrosis
What is the most common dislocated hand bone?
lunate bone
Boxer’s Fracture
metarpal neck
Nursemaid’s Neck
radial head subluxes out of the annular ligament
What is the blood supply to the hip in adults
medial femoral circumflex artery
What is the blood supply to the hip in children?
minor contribution from the ligament of the head of the femur (via the obturator)
Butt injections want to avoid
the superficial gluteal nerve
sciatic nerve
Safe place to do butt injections
superolateral quadrant
Most likely to injure the sciatic nerve via
posterior hip dislocation
What is the presentation of a posterior hip disloation?
leg is shortened, adducted & internally rotated
What is the presentation of a hip fracture
leg is externally rotated
Trendelenberg sign is a result of
paralysis of gluteus medius/minimus due to superior gluteal nerve injury leads to loss of abduction
Trendelenberg sign
drop of the contralateral side with lean to the ipsilateral sign
What happens in an obturator nerve injury?
decreased sensation over the medial thigh
Popliteal Fossa
tibial nerve
popliteal vein
popliteal artery
What is the deepest artery near the knee joint?
popliteal artery
Knee dislocation can endanger
the popliteal artery
Tibial Nerve Loss
motor
sensory
motor: can’t stand on toes (plantarflex)
sensation: sole of foot
Fibular neck frature leads to
common peroneal nerve injury, leading to foot drop
How would you distinguish between a deep peroneal nerve injury vs. common peroneal nerve injury?
in common peroneal
sensory loss: no sensation only in area between the 2 medial toes
What are the knee liaments?
ACL (anterior cruciate; lateral to medial)
PCL (posterior cruciate; medial to lateral)
medial collateral (MCL)
lateral collateral
which ligament of the knee is susceptible to valgus stress? Varus?
valgus: MCL
varus: LCL
Unhappy Triad
lateral strike (valgus stress)
tibial/medial collateral ligament
ACL
meniscus
Inversion ankle sprain caused by
anteriortalofibular ligament
Pott’s Fracture
Eversion
deltiod ligament
medial malleolus fracture
higher level fibular fracture
Plantar Fasciitis
plantar surface pain from calcaneal spur
Spring Ligament
supports the medial arch and most of the weight of the foot
Dancer’s Fracture
5th metatarsal avulsion
What are the borders of the femoral triangle?
superior: inguinal ligament
lateral: sartorious
medial: adductor longus
What are the contents of the femoral triangle?
(from lateral to medial)
femoral nerve
femoral artery
femoral vein
femoral canal (which contains deep lymph nodes)
the femoral artery, vein, and canal are within the femoral sheath
Femoral Hernia
part of the bowel pushes through the inguinal canal, under the inguinal ligament
Suprascapular Notch Significance
the susprascapular artery goes above the notch to anastoamose w/ the circumflex scapular
Superficial branches of the Femoral Artery
superficial pudendal
superficial epigastric
superficial circumflex iliac
List the main branches of the axillary artery
first part: superior thoracic
second part: thoracoacromial, lateral thoracic
third part: subscapular artery, anterior & posterior circumflex
