Blue Boxes U.E. Flashcards
Arterial Anastomoses around scapula
Due to extensive anastomoses around the scapula, to cut off all blood supply to the arm, ligation must be distal to the Subscapular A. of the Axillary A. Ligation of Axillary A. between the Thyrocervical Trunk and Subscapular A. results in a reversal of blood flow in the Subscapular A. due to collateral circulation arriving via Suprascapular, Transverse Cervical and Subscapular A. to the scapular region and continued feed of arterial blood to the Brachial A.
Aneurysm of Axillary Artery
Region one of the Axillary A. is susceptible to aneurysm in individuals experiencing repeated rapid arm movements (like Baseball Pitchers) and can compress the Brachial Plexus, resulting in pain and loss of sensation.
Injuries to Axillary Vein
Injuries to the axilla usually involve the axillary vein because it is large and exposed. A wound in the proximal part is dangerous because it can cause profuse bleeding and there is a risk that air can enter it and produce air bubbles in the blood
The axillary vein in Subclavian Vein Puncture
The Median Cubital V. is the most common site of venipuncture because of its superficial location and the protection of underlying deep structures by the Bicipital Aponeurosis.
Infection of Axillary lymph nodes
The Axillary Lymph Nodes are important due to their frequent invasion by cancer cells from elsewhere in the body (usually breast)
Lymphangitis: inflammation of lymphatic vessels, usually red, tender streaks in the skin of the limb. The apical nodes can enlarge and adhere to the axillary vein and cut of the cepalic vein
Dissection of Axillary Lymph nodes
To determine the appropriate cancer treatment, (ex. breast cancer) axillary lymph nodes must be removed. Sometimes lymphhedema occurs after removal which is swelling in response to accumulated lymph. This is risky because if you cut the long thoracic nerve to serratus anterior, you get a winged scapula and you could also cut the thoracodorsal nerve.
Variations of Brachial Plexus
C4–> C8 = prefixed B.P
C6 –> T2 = postfixed B.P.
Brachial Plexus Injuries
Injury to the superior part of the Brachial Plexus (Upper Plexus Injuries) typically affect C5 and C6 Anterior Rami and are usually the result of dramatically increasing the angle between the Neck and the Shoulder. Such an action can stretch, rupture or avulse the Spinal roots off of the Spinal Cord. An individual with an Upper Plexus Injury will have an Adducted and Medially Rotated Arm and an Extended Elbow, also known as Erb-Duchenne Palsy or “Waiter’s Tip Position.”
Injury to the inferior part of the Brachial Plexus is less common that Upper Plexus Injury and is usually the result of dramatically increasing the angle between the trunk and upper limb. This typically affects the short muscles of the Hand and results in “Claw Hand” when the individual tries to make a fist, also known as Klumpke Paralysis.
Compression of the Cords of the Brachial Plexus usually result from prolonged periods of working with the upper limb extended over the Head, this results in pain radiating down the Arm, loss of sensation, tingling of the arms and weakness of the Hands
Bicipital Myotactic Reflex
Striking the thumb placed over the Bicipital Tendon with a reflex hammer should produce a Bicipital Myotactic Reflex, failure of the tendon to tighten up and the Forearm to flex slightly could suggest injury to the Musculocutaneous N. or C5 and C6 Anterior Rami.
Biceps Tendinitis/Tendinosis
Repetitive movement of the Long Head of the Biceps T. through the Intertubercular Groove
makes that tendon susceptible to inflammation, known as Biceps Tendinitis, and even Crepitus, a
crackling sound.
Tendinosis = degeneration w/in the tendons collagen causing disorganization of the collagen in response to poor vascularization, chronic overuse, or aging
All common in sports involving throwing
Tendon of long head of biceps brachii dislocation & Rupture
The tendon is capable of dislocating out of the Intertubercular
Groove or even separating entirely from the Supraglenoid Tubercle, which results in the muscle
balling up in the mid arm, a condition known as “Popeye Deformity.”
-Usually in weight lifters, swimmers, baseball pitchers
Interruption of Blood Flow in Brachial Artery
The brachial artery is how you take blood pressure
Hemostasis: Stopping bleeding through manual/surgical control (Stop hemorrhage @ medial to humerus, near the middle of the arm)
Muscles + nerves can tolerate 6 hours of ischemia before tissue death & compartement syndrome (flexion deformity)
Nerve Injury in Fracture of Humeral Shaft
A midhumeral fracture may injure the radial nerve, but is not likely to paralyze the triceps because of its 3 heads
A supra-epicondylar fracture (distal humerus) causes distal bone fragments to be displaced an injure nerves
Injury to Musculocutaneous Nerve
Injury to the Musculocutaneous N., while rare is possible with blunt force trauma and renders the anterior Brachial muscles paralyzed
Injury to Radial Nerve in Arm
CN: Injury of the Radial N. results in “Wrist Drop,” impairment of elbow extension and thumb abduction and extension
Venipuncture in Cubital Fossa
The Median Cubital V. is the most common site of venipuncture because of its superficial location and the protection of underlying deep structures by the Bicipital Aponeurosis.
Elbow Tendinitis/Tendinosis or Lateral Epicondylitis “Tennis Elbow”
Repetitive use of the Superficial Extensor muscles of the Forearm can result in Elbow Tendinitis, or “Tennis Elbow,” and involves pain over the Lateral Epicondyle and down the posterior Forearm. Repeated flexion and extension of the Wrist strains the Periostium of the Lateral Humeral Epicondyle, called Lateral Epicondylitis.
Mallet or Baseball Finger
Sudden hyperflexion of the Distal Interphalangeal Joint can avulse the attachment of the long extensor tendon with that tendon away from the Distal Phalanx, a condition known as “Mallet Finger,” or “Baseball Finger.”
Fracture of the Olecranon “Fracture of the Elbow”
Fracture of the Olecranon, often referred to as “Fractured Elbow” is common in cases of falling on the elbow, because of the forceful nature of the Triceps Brachii M. pulls it back, this is considered an avulsion fracture and is difficult to repair.
Synovial Cyst of Wrist
Irritation of the Synovial Sheaths can cause an accumulation of mucopolysaccharide fluid that can form a usually painless lump known as a Synovial, or Ganglion Cyst. Infections of the Synovial Sheath can cause swelling in very specific and characteristic configurations that follow the shapes of these sheaths.
High Division of Brachial Artery
Brachial artery divides at the top of the arm instead of at the cubital fossa & the median nerve passes beween them
Superficial Ulnar Artery
In 3% of people the ulnar artery is superficial to the flexor muscles… this can be really bad if you are taking someones blood! sometimes fatal if injecting drugs
Measuring Pulse Rate
The common place for measuring pulse is where the radial artery lies on the anterior surface of the distal end of the radius
Here the artery is only covered by fascia & skin
DO NOT take pulse on thumb (thumb has its own pulse)
Variations in Origin of Radial Artery
Sometimes the radial artery may be more proximal than usual (branch in arm) & sometimes it is superficial to deep fascia