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
Median Nerve Injury
Injury of the Median N. in the Wrist results in an Adducted Thumb and Thenar eminence atrophy, known as Ape’s Hand. Injury to the Median N. at the Elbow inhibits flexion of 2nd and 3rd digits, known as Hand of Benediction, as well as the symptoms of Ape’s Hand.
Pronator Syndrome
“nerve entrapment”
- Compression of median nerve near the elbow
- Symptoms: pain/tenderness in poximal aspect of anterior forearm & hypesthesia (decreased sensation) of palmar aspects of the thumb and first 2 fingers
Communications between median and ulnar nerves
Even w/ a complete lesion of the median nerve, some muscles may not be paralyzed
Injury of Ulnar Nerve @ Elbow and in forearm
Ulnar N. injury typically occurs in one of four places: posterior to the Medial Humeral Epicondyle, between the Ulnar and Humeral Heads of the Flexor Carpi Ulnaris M. (the socalled Cubital Tunnel), at the Wrist or in the Hand. The overall results are similar, extensive loss of sensory and motor control in the Hand, and when an individual tries to make a fist it appears as “Claw Hand.”
The Groove for the Ulnar N. houses the Ulnar N. and when compressed is painful. This is the origin of the expression “funny-bone” relating to the presence of the Ulnar N. in this groove on the Humerus (humorous = funny).
Cubital Tunnel Syndrome
The ulnar nerve may be compressed “ulnar nerve entrapment” in the cubital tunnel (tendinous arch joining the humeral + ulnar heads)
Injury of Radial Nerve in Forearm (superficial or deep branches)
Injury of the Radial N. results in “Wrist Drop,” impairment of elbow extension and thumb abduction and extension
Dislocation of Sternoclavicular joint
- Very rare for the sternoclavicular joint to dislocate*
- Usually a blow or fall just transmits to clavicle & causes it to break
The Clavicle is one of the most fractured bones due to direct and indirect injuries received by falling. Fractures in younger children are often incomplete and referred to as a “Greenstick” fracture.
Ankylosis of Sternoclavicular Joint
-Ankylosis: Stiffening or fixation
* Movement @ the SC Joint is critical to movement of the shoulder*
-When ankylosis occurs a section of the center clavicle is removed so that the scapula can “flail” to move
Dislocation of Acromioclavicular Joint
The Acromioclavicular Joint is susceptible to injury and separation, often referred to as “Shoulder separation,” and is capable of separating with or without rupture of the Coracoclavicular L.
Calcific Tendinitis of Shoulder
- Calcium deposits in the supraspinatus tendon
- Causes excruciating pain when you abduct your arm
- Also called calcific scapulohumeral bursitis becuse the calcium deposit can irritate the overlying subacromial bursa –> producing an inflammatory reaction subacromial bursitis
Rotator Cuff Injuries
The Supraspinatus, Infraspinatus, Teres Minor and Subscapularis Ms. are collectively referred to as the Rotator Cuff muscles and offer stability to the Glenohumeral Joint. Trauma can injure or tear any of the Rotator Cuff muscles resulting in instability of the Glenohumeral Joint. The Supraspinatus is the most commonly injured.
- Can cause degererative tendonitis of the rotator cuff
- If you ask them to abduct their arm it will randomly drop
Dislocation of Glenohumeral Joint
The Glenohumeral Joint is susceptible to dislocation due to its mobility and relative instability. Due to the presence of the Coracoacromial Arch dislocation of the Glenohumeral Joint most commonly occurs anteriorly or inferiorly.
Glenoid Labrum Tears
Tearing of the fibrocartilaginous gleniod labrum commonly occurs in athletes who throw a baseball or football & who have partial dislocation of the joint.
The Glenoid Labrum commonly tears in individuals repeatedly throwing a ball, usually in response to a sudden contraction of the Biceps Brachii M. and occurs in the anterosuperior part of the Labrum.
Adhesive Capsulitis “Frozen Shoulder” of Glenohumeral Joint
Adhesive fibrosis & scarring between the inflamed joint capsule of the glenohumeral joint, rotator cuff, and subacromial bursa, and deltoid usually cause adhesive capsulitis “frozen shoulder”
- 40-60 years old
- puts strain on AC joint
Bursitis of Elbow
Two of the more common Bursae to become inflamed are the Subcutaneous Olecranon Bursa and the Bicipitoradial Bursa.
Subcutaneous Olecranon Bursitis, sometimes called “Student’s Elbow,” “Dart thrower’s Elbow” and “Miner’s Elbow” results from excessive friction between the Skin and the Olecranon.
Avulsion of Medial Epicondyle
- Avulsion = forced seperation*
- Caused from a fall that causes severe abduction of extended elbow
- Flexor muscles detach from the medial epicondyle and ulnar collateral ligament pulls the medial epicondyle distally, sometimes affects the ulnar nerve
Ulnar Collateral Ligament Reconstruction
The ulnar collateral ligament is commonly ruptured in athletic throwing, like baseball pitching
They take palmaris longus or another tenden and attach it to the medial epicodlye of humerus and lateral aspect of coronoid process of ulna
Dislocation of Elbow Joint
The Elbow is capable of being dislocated posteriorly in response to force transmitted along the long axis of the Forearm, this usually involves a tear in the Ulnar Collateral L.
Subluxation & Dislocation of Radial Head (Nursemaid’s Elbow or Pulled Elbow)
The Radial Head is capable of being dislocated out of the Annular L. to varying degrees, this injury typically occurs from pulling on the arm of a child, sometimes called “Nursemaid’s Elbow” or “Pulled Elbow.”
- Source of pain = pinched annular L.
- Kid holds elbow and has it pronated –> treatment = supination
Wrist Fractions and Dislocations
Fractures of the Distal End of the Radius (from breaking falls) are common in people over 50 and are referred to as Colle’s fracture. The Styloid Process of the Ulna is often also avulsed in this situation.
The Scaphoid is the most commonly fractured Carpal Bone, and is usually the result of trying to break a fall, often the fracture in not visible on a radiograph and therefore misdiagnosed as a severe sprain. The distal fragment of bone is susceptible to avascular necrosis since it is usually separated from its blood supply.
Bull Rider’s Thumb
Sprain of the Lateral Collateral L. and even avulsion of the lateral Part of the Proximal Phalanx of the Thumb is an injury common to individuals who ride a Mechanical Bull and is therefore known as “Bull Rider’s Thumb.”
Skier’s thumb/Gamekeepers Thumb
Laxity or rupture of both collateral ligaments (medial + lateral) of the 1st Metacarpophalangeal Joints results in a hyperabduction of MP joint and is referred to as “Skier’s Thumb,” or “Game-keeper’s Thumb.”
-Thumb is held by ski pole while rest of hand hits the ground
Duputyren Contracture of Palmar Fascia
Dupuytren Contracture is a disease resulting in the shortening, thickening and fibrosis of the Palmar Aponeurosis and Palmar Fascia, that results in a partial flexion of the 4th and 5th Digits.
Hand Infections
When you get a hand infection, pus accumulates in the spaces of the thenar, hypothenar, midpalmar, or adductor compartments
If not treated w/ antibiotics then it can spread in through the carpal tunnel and the forearm
Tenosynovitis
Injuries such as a puncture of a finger by a rusty nail can cause infection of the digital synovial sheaths, which causes inflammation of the tendon and tenosynovitis occurs –> the digit swells and movement becomes painful.
“Trigger finger” –> tendons enlarge proximal to carpal tunnel and person is unable to extend finger + tendon “snaps” when flexed or extended passively
Laceration of Palmar Arches
When the palmar arches are lacerated, bleeding is profuse, becuase of the elbow anastomoses you may have to compress the brachial artery proximal to the elbow
Ischemia of Digits (Fingers)
- Brought on by cold or emotional stimuli
- Condition is Idiopathic/Unknown = Raynaud Syndrome
- Might need to preform a codorsal presynaptic sympathectomy (excision of a segment of sympathetic nerve) to dilate the digital arteries
Lesions of Medial Nerve
Usually occur @ forearm + wrist
-Most common site is where nerve passes through the carpal tunnel
Carpal Tunnel Syndrome
The passage anterior to the Carpal Bones posterior to the Flexor Retinaculum is known as the Carpal Tunnel and transmits the tendons of the Flexor Digitorum Profundus and Superficialis Ms. as well as the Flexor Carpi Radialis T. and Median N. If swelling of the tendons occurs the Median N. can be compressed resulting in Carpal Tunnel Syndrome, which produces parasthesia (tingling), anesthesia and pain in lateral 3 1/2 digits + can’t oppose thumbs
- -C.T.S. results from any lesion that significantly reduces the size of the tunnel or increases the size of the structures that pass through it*
- May have to surgically cut the flexor retinaculum to relieve pressure/symptoms
Trauma to Median Nerve
Laceration to the wrist often causes median nerve injury, because this nerve is relatively close to the surface
-Ex: attempted suicide by wrist slashing
The complicated action of opposition of the thumb can be lost with injury to the Median N. Even a very superficial injury of the palm can damage the recurrent branch of the Median N. which innervates the muscles involved in opposition.
Ulnar Canal Syndrome
Compression of the ulnar nerve may occur at the wrist where it passes between the pisiform and the hook of hamate
The depression between the Pisiform and Hamulus of the Hamate is known as the Ulnar Canal (Guyon Tunnel) and the Ulnar N. passes through this canal and is susceptible to compression, which manifests as loss of sensation (hypoesthesia) and muscular weakness.
Handlebar Neuropathy
The Ulnar N. can be compressed when pressure is placed on the Hamulus of the Hamate B., like when riding a bike. This can produce sensory loss on the medial side of the hand and weakness of the intrinsic hand muscles and is often referred to as “Handlebar Neuropathy.”
Radial Nerve Injury in Arm & Hand Disability
-Inability to extend the wrist from paralysis of extensor muscles in the forearm (all innervated by radial nerve)
Wrist-drop
Dermatoglyphics
The science of studying ridge patterns of the palm
Palmar Wounds & Surgical Incisions
The superficial palmar arch is @ the same level as the distal end of the common flexor sheath
Incisions or wound along the medial surface of the thenar eminence may injure the recurrent branch of the median nerve to the thenar muscles
