Blue Boxes Flashcards
1
Q
Variations of Clavicle
A
- vary more in shape than most other long bones
- sometimes pierced by a branch of the supraclavicular nerve
- clavicle is thicker and more curved in manual workers, and the sites of muscular attachments are more marked.
2
Q
Fracture of Clavicle
A
- often caused by indirect force transmitted from an outstretched hand through the bones of the forearm and arm to the shoulder during a fall, or a fall directly on the shoulder.
- weakest part of clavicle: junction of middle and lateral thirds
- after fracture, the SCM elevates the medial fragment of bone…trapezius is unable to hold the lateral fragment up owing to the weight of the upper limb, thus the shoulder drops.
3
Q
Greenstick Fracture
A
Fracture of the clavicle is often incomplete in younger children-that is, it is a greenstick fracture, in which one side of a bone is broken and the other is bent.
4
Q
Ossification of the Clavicle
A
clavicle = 1st long bone to ossify (via intermembranous ossification)
5
Q
Fracture of scapula
A
- usually result of severe trauma, and fractured ribs
- most fractures require little treatment because the scapula is covered on both sides by muscles
- most fractures involve the protruding subcutaneous acromion
6
Q
Fractures of the humerus: Types
A
- fracture of surgical neck: common in osteoporosis
- impacted fracture: 1 fracture being driven into the spongy bone of the other fragment
- avulsion fracture of greater tubercle: usually results from fall on the acromion, the point of the shoulder (muscles attached pull limb in medial rotation)
- transverse fracture of shaft: direct blow to arm
- spiral fracture of humeral shaft: indirect from fall on outstretched hand
- intercondylar fracture: severe fall on flexed elbow; olecranon (ulna) driven between the medial and lateral parts of the condyle of the humerus, separating one or both parts from humeral shaft.
7
Q
Fractures of Humerus: Associated Nerves
A
Surgical Neck: axillary n.
Radial groove: radial n.
distal end of humerus: median n.
medial epicondyle: ulnar n.
8
Q
Fractures of Radius and Ulna
A
- Fracture of distal end of radius: common >50 yo. >women
- Colles Fracture: complete transverse fracture of the distal 2 cm of radius
- distal fragment is displaced dorsally and is often comminuted
- results from forced extension of the hand, usually as the result of trying to ease a fall by outstretching the upper limb.
- dinner fork deformity
9
Q
Fracture of Scaphoid
A
- most frequently fractured carpal bone
- often results from fall on the palm when the hand is abducted, fracturing across the narrow part of the scaphoid.
- pain primarily on lateral side of wrist, especially during dorsiflexion and abduction of the hand.
10
Q
Fracture of Hamate.
A
- may result in non-union of the fractured bony parts because of the traction produced by the attached muscles.
- ulnar n. may be injured, causing decreased grip strength.
- ulnar a. may also be damaged when the hamate is fractured.
11
Q
Fracture of metacarpals.
A
- severe crushing injuries of the hand may produce multiple metacarpal fractures, resulting in instability of the hand.
- fracture of the 5th metacarpal, often referred to as a “Boxer’s Fracture”, occurs when an unskilled person punches someone with a closed and abducted fist; the head of the bone rotates over the distal end of the shaft, producing a flexion deformity.
12
Q
Fracture of Phalanges.
A
- crushing injuries of the distal phalanges are common, extremely painful due to highly developed sensation
- fracture of a distal phalanx is usually comminuted, and a painful hematoma soon develops.
- fractures of the proximal and middle phalanges - usually result of crushing or hyperextension injuries
13
Q
Absence of Pectoral Muscles
A
- part of pectoralis major absence, usually its sternocostal part, is uncommon, but when it occurs, no disability usually results.
- but, the anterior axillary fold, formed by the skin and fascia overlying the inferior border of the pectoralis major, is absent on the affected side, and the nipple is more inferior than usual.
- Poland Syndrome: both the pectoralis major and minor are absent; breast hypoplasia and absence of 2 to 4 rib segments are also seen.
14
Q
Paralysis of Serratus Anterior
A
- injury to long thoracic n.
- medial border of scapula moves laterally and posteriorly, away from the thoracic wall, giving the scapula the appearance of a wing.
- in addition, the upper limb may not be able to be abducted above the horizontal position because the serratus anterior is unable to rotate the glenoid cavity superiorly to allow complete abduction of the limb.
15
Q
Triangle of Auscultation
A
- near inferior angle of scapula; small gap in musculature.
- superior horizontal border of latissimus dorsi
- medial border of the scapula
- inferolateral border of trapezius
- examine posterior segments of the lungs
16
Q
Injury of Spinal Accessory Nerve (CN XI)
A
-primary clinical manifestation of spinal accessory nerve palsy = marked ipsilateral weakness when the shoulders are elevated (shrugged) against resistance.
17
Q
Injury of Thoracodorsal N.
A
- sx in inferior part of the axilla puts the thoracodorsal n. (C6-C8), supplying the latissimus dorsi, at risk of injury.
- n. passes inferiorly along posterior wall of the axilla, and enters the medial surface of the latissimus dorsi close to where it becomes tendinous.
- n also vulnerable to injury during mastectomies when the axillary tail of the breast is removed.
18
Q
Injury to Dorsal Scapular N.
A
-injury to the dorsal scapular n., the n. to the rhomboids, affects the actions of these muscles. If the rhomboids on one side are paralyzed, the scapula on the affected side is located farther from the midline than that on the normal side.
19
Q
Compression of Axillary Artery
A
- palpated in inferior part of lateral wall of axilla
- compression of the 3rd part of this artery against the humerus may be necessary when profuse bleeding occurs
- can be compressed at origin (as subclavian a. crosses 1st rib) by exerting downward pressure in the angle between the clavicle and the inferior attachment of the SCM muscle.
20
Q
Aneurysm of Axillary Artery
A
- 1st part of axillary a. may enlarge and compress the trunks of the brachial plexus, causing pain and anesthesia (loss of sensation) in areas of skin supplied by affected nerves.
- aneurysm may occur in baseball pitchers and football quarterbacks from rapid and forceful arm movements
21
Q
Injuries to Axillary Vein
A
- wounds in axilla often involve the axillary v. because its large and exposed.
- when arm is fully abducted, the axillary vein overlaps the axillary artery anteriorly.
- wound in proximal part of axillary vein is particularly dangerous, not only because of profuse bleeding but also because of the risk of air entering it and producing air emboli in the blood.
