Blue Boxes: Upper Extremity Flashcards
Understand disease/pathological states associated with issues in upper extremity osteology, arthrology, myology, angiology, and neurology.
What are Greenstick fractures?
Clavicle fractures in children are most often what type of fracture?
Clavicle fractures in children
One of the most frequently fractures bones
What happens if the fusion of the two ossification centers of the clavicle fail to occur?
Bony defect forms between the lateral and medial thirds of the clavicle
Awareness of this possible congenital defect should prevent diagnosis of a fracture in an otherwise normal clavicle
What should you be concerned about with scapular fractures?
Protruding subcutaneous acromion
Scapular Fractures are rare (result of severe trauma) and require little treatment due to the muscles that surround it
What is the most common site of fracture on the humerus?
Surgical neck
Greater tubercle is also susceptible to avulsion by the supraspinatus, infraspinatus, and teres minor muscles that insert there
What nerves correspond to these sites of the humerus?
Surgical Neck
Radial Groove
Distal end of the humerus
Medial Epicondyle
Surgical Neck: Axillary Nerve
Radial Groove: Radial Nerve
Distal end of the humerus: Median Nerve
Medial Epicondyle: Ulnar Nerve
What can cause a glenoid labrum tear?
Injuries to tissue rim surrounding shoulder socket from acute trauma or repetitive shoulder motion
- Falling on an outstretched arm
- A direct blow to the shoulder
- A sudden pull, such as when trying to lift a heavy object
- A violent overhead reach, such as when trying to stop a fall or slide
What nerve is compressed when you hit your “funny bone”? Where is it located?
Ulnar Nerve at the groove for the Ulnar N.
What can cause an avulsion (pulling away) of medial humeral epicondyle?
Severe abduction of extended elbow
Which bone is fractured in a fractured elbow?
Olecranon: Usually avulsion fracture and difficult to repair
Normally caused by falling
What is Colle’s Fracture
Fracture at the distal end of the radius
Can be accompanied with evulsion of ulnar styloid process
Most common in adults over 50 and those with osteoporosis
What is the most commonly fractured carpal bone?
Scaphoid
Results from a fall on the palm when the hand is abducted
FOOSH
What can cause a fracture of the Hamate?
What nerve can be potentially injured?
Traction produced by attached hypothenar muscles can cause the fractured bony parts to join together
Ulnar Nerve close tho hamate
What is typically injured in a Boxer’s Fracture?
Fracture of the 5th metacarpal
What is unique about fractures of distal phalanges?
Can be bad due to intricate relationship between phalanges and flexor tendons bone fragments
Need to be realigned carefully to maintain function
What is agenesis?
Failure of body part or organ to form, usually due to a lack of genetic signaling to produce primordial tissue and failure of subsequent development in the embryo
What is Poland Syndrome?
Agenesis of the Pectoralis Major and Pectoralis Minor
-can also see breast hypoplasia nad absence of 2-4 rib segments
What happens if the Serratus Anterior Muscle or Long Thoracic Nerve is injured?
Winging of the Scapula
- Upper limb will not elevate normally above the horizontal position
- Serratus anterior is unable to upwardly rotate the scapula to position the glenoid cavity superiorly to allow complete abduction or elevation of the limb
What is the Triangleo f Auscultation?
Gap in the back musculature to examine lungs
Borders:
- Superior horizontal border of the latissimus dorsi
- Medial border of the scapula
- Inferolateral border of the trapezius form a triangle of auscultation
What happens if there is a Spinal Accessory Nerve Injury?
“Dropped” shoulder with a marked ipsilateral weakness when the shoulders are elevated (shrugged) against resistance
Weakness in Trapezius Muscle
How can the Thoracodorsal Nerve be injured?
What can happen if it is injured?
Surgery in inferior part of axialla puts the nerve at risk
-also vulnerable during mastectomies
Clinical Manifestations: Unable to raise trunk wiht upper limbs (can’t climb)
What happens if Dorsal Scapular Nerve is injured?
Rhomboid and Levator Scapulae Muscles affected
-If rhomboids on one side are paralyzed, the scapula on the affected side is located farther from the midline than that on the normal side
What happens if Axillary Nerve is injured?
How can this happen?
Atrophy to Deltoids and Teres Minor Muscles
- Shoulder: flattened appearance and produces a slight hollow inferior to the acromion.
- Loss of sensation may occur over the lateral side of the proximal part of the arm (via s**uperior lateral cutaneous nerve)
Causes:
- Injury to surgical neck of humerus
- Anterior dislocation of glenohumeral joint
- Compression from incorrect use of crutches
What happens if there is a fracture or dislocation of Proximal Humeral Epiphysis?
Cause: Direct blow or indirect injury of the shoulder in children/adolescents
- Joint capsule of the glenohumeral joint is reinforced by rotator cuff and is stronger than the epiphysial plate
- Severe fractures: shaft of the humerus is markedly displaced, but the humeral head retains its normal relationship with the glenoid cavity of the scapula
What happens in rotator cuff injuries?
Instability of Glenohumeral Joint
Trauma can tear or rupture one or more tendons (most commonly Supraspinatus Muscle)
Where are the three scapular anastomoses?
If you want to cut off blood supply to the Upper Extremity, where can place ligatures?
- B/t Suprascapular and Circumflex Scapular Arteries
- B/t Circumflex Scapular and Dorsal Scapular Arteries
- B/t Thoracodorsal and Dorsal Scapular Arteries
Before Thyrocervical Trunk or After Subscapular Arteries
What are some injuries that can happen to the Axillary Artery?
Compression: Happens in third part of the axillary artery against humerus (normally to stop profuse bleeding)
Aneurysm: Happens in first part of the axillary artery and can compress brachial plexus, causing pain or loss of sensation
Can occur in football or baseball players due to their arm movements
Other Injuries: Proximal wound can cause profuse bleeding or air emboli in blood
How does the axillary vein play a role in the Subclavian Vein Puncture?
Axillary vein becomes subclavian vein when it passes the first rib so the puncture happens in the terminal part of axillary vein
When there is an infection of the lymph nodes, which lymph nodes are normally first invovled?
Axillary Nodes: humeral group of nodes
During an axillary lymph node dissection, what two nerves are at risk of injury?
- Long Thoracic Nerve
- Thoracodorsal Nerve
What are some injuries of the Brachial Plexus?
1. Erb-Duchenne Palsy: Injury to superior parts of brachial plexus
2. Brachial Plexus Neuropathy: Severe pain around shoulder
3. Klumpke Paralysis: Injury to inferior parts of brachial plexus
The bicipital myotatic reflex can suggest injuries in what area?
Injury to Musculocutaneous Nerve or C5 and C6 Anterior Rami
What is Biceps Tendinitis?
Inflammation of the biceps tendon from microtears
-Repetitive microtrauma (common in sports)
How can the Long Head of the Biceps be injured?
1. Dislocation of Tendon of Long Head of Biceps: Tramuatic separation of long head from proximal humerus
Normally in young kids or older people
2. Rupture of Tendon of Long Head of Biceps: Wear and tear of inflammed tendon or torn from scapula
Normally happens from prolonged biceps tendonitis
What happens if Musculocutaneous Nerve is injured?
Paralysis of the coracobrachialis, biceps, and brachialis and loss of sensation to lateral surface of forearm supplied by lateral cutaneous nerve of forearm
What would happen if the Radial Nerve is injured?
Paralysis of the triceps, brachioradialis, supinator, and extensor muscles of the wrist and fingers
Classic sign: wrist drop
Where would you peform venipuncture in cubital fossa?
Most commonly done in median cubital vein
What is Lateral Epicondylitis?
“Tennis Eblow”
Pain is felt over the lateral epicondyle and radiates down the posterior surface of the forearm
What is Mallet Finger/Baseball Finger?
Hyperflexion of distal interphalangeal joint: avulses long extensor tendon
What can cause a fracture of the olecranon?
Fall on the elbow combined with sudden powerful contraction of the triceps brachii
-Subcutaneous and protrusive
What is a Ganglion Cyst (Synovial Cyst)?
Accumulation of mucopolysaccharide fluid in the hand
- Normally not painful
- Can cause Carpal Tunnel Syndrome
What will happen if the median nerve is injured?
- Flexion of proximal interphalangeal joints of the 1st–3rd digits is lost and weakened in the 4th and 5th digits.
- Flexion of the distal interphalangeal joints of the 2nd and 3rd digits is also lost.
- Flexion of the metacarpophalangeal joints of the 2nd and 3rd digits is affected because the digital branches of the median nerve supply the 1st and 2nd lumbricals
- Hand of Benediction*
What happens if ulnar nerve is injured?
Nerve passes posterior to the medial epicondyle of humerus
-Numbness and tingling of medial part of the palm and medial one and a half fingers
What is pronator syndrome?
Nerve entrapment syndrome: compression of median nerve near the elbow
- Pain and tenderness in the proximal aspect of the anterior forearm
- Decreased sensation of palmar asoects of radial three and half digits and adjacent palm
What is cubital tunnel syndrome?
Ulnar Nerve entrapment in cubital tunnel
-symptoms similar to ulnar nerve lesion
What happens if you injure radial nerve in forearm?
Due to fracture of humeral shaft
-Injury to extensor muscles
What is in the carpal tunnel? Where is it located?
Passage anterior to carpal bones and posterior to flexor retinaculum
Transmits the tendons of flexor digitorum profundus and superficialis m. and flexor carpi radialis m. and Median n.
Guyon tunnel
AKA Ulnar Tunnel- located between pisiform and hamulus of hamate Ulnar nerve passes thru (susceptible to compression; numbness and weakness in wrist and hand)
What happens in a shoulder separation?
Separation of the acromioclavicular joint w/ or without rupture of coracoclavicular l.
Dislocation of the glenohumeral joint occurs in which directions?
Anteriorly and inferiorly
Elbow dislocation usually involves a tear in what ligament?
Ulnar collateral l.
“Student’s Elbow/Dart Thrower’s Elbow”
-Subcutaneous olecranon bursitis
Inflammation of subcutaneous olecranon bursa and bioccipital bursa
Nursemaid’s elbow/ Pulled elbow
Radial head dislocated out of the annular ligament (Don’t pull your kiddos arm)
Bull Rider’s Thumb
Sprain of the lateral collateral ligament of the proximal phalynx of the thumb
Skiier’s Thumb
Laxity or rupture of both collateral ligaments (medial and lateral ligaments) in first metacarpophalangeal joint Caused by hyperabduction
Dupuytren Contracture
Disease from shortening, thickening, fibrosis of palmar aponeurosis and palmar fascia Pain flexing 4th and 5th digits
Triangular Space Borders
Teres minor m. Teres major m. Long head of triceps brachii m.
Triangular Space Contents
Circumflex scapular a. and v.
Quadrangular space borders
Teres minor m. Teres major m. Long and lateral heads of triceps brachii m.
Quadrangular space contents
Posterior humeral circumflex a and v. Axillary n.
Triangular interval borders
Teres major m. Long and lateral heads of triceps brachii.
Triangular interval contents
Deep brachial a. and v. Radial n.
Triangular interval contents
Deep brachial a. and v. Radial n.
