Chapter 6: Upper Limb Flashcards
(152 cards)
1
Q
How are clavicular fractures often caused? (2)
A
1) indirect force transmitted via an outstretched hand through the bones of the forearm/ arm to the shoulder during a fall
2) fall directly on the shoulder
2
Q
T/F: The clavicle is one of the most frequently fractured bones.
A
true
3
Q
Where is the weakest part of the clavicle?
A
the junction of its middle and lateral thirds
4
Q
Clavicular fractures are especially common in what population?
A
children
5
Q
What anatomy differences occur following a clavicle break?
A
- the sternocleidomastoid muscle elevates the medial clavicle, making it palpable
- trapezius is unable to elevate the lateral clavicle anymore due to the weight of the arm, so the shoulder drops
6
Q
What ligament usually prevents dislocation of the acromioclavicular joint?
A
coracoclavicular ligament
7
Q
What is a greenstick fracture?
A
- where one side of a bone is broken and the other is bent; a bone just bends and cracks, doesn’t break into two parts
- this kind of fracture will occur in younger kids with their clavicles
8
Q
How does a fracture of the scapula occur? How do you treat?
A
- only through severe trauma (pedestrian vs. car accident), and usually ribs are fractured as well
- little treatment because scapula is surrounded on both sides by muscles
9
Q
Where do most injuries of the proximal humerus occur, and who are they most common in?
A
surgical neck; older people with osteoporosis
10
Q
T/F: Fractures of the radius and ulna are not that hard to do.
A
false, usually the result of severe injury
11
Q
Due to the interosseus membrane holding together the radius and ulna, a fracture of one of those bones is likely to be associated with what other injury?
A
dislocation of the nearest joint
12
Q
What is the most common fracture of the forearm? How does it result?
A
- colles fracture; complete transverse fracture of the distal 2cm of the radius
- results from forced extension of the hand, usually trying to ease a fall
13
Q
How does a “dinner fork deformity” result?
A
colles fracture; posterior angulation results
14
Q
What is the most frequently fractured carpal bone? How does it usually happen?
A
- scaphoid; fallling on palm when hand is abducted
15
Q
When fracturing the hamate, what nerve can be injured? What motions will this limit?
A
ulnar nerve, causing decreased grip strength
16
Q
T/F: Fractures of the metacarpals tend to heal slowly.
A
false, heal pretty rapidly if they are isolated and stable, and because they have a good blood supply
17
Q
What’s a boxers fracture, and how does it happen?
A
fracture of the 5th metacarpal, occurs when an unskilled person punches someone with a closed and abducted fist
18
Q
T/F: Crushing injuries of the distal phalanges are common.
A
true, think car door slamming on fingers
19
Q
What is a comminuted fracture?
A
fractured into more than two pieces
20
Q
What is the first long bone to ossify and the last to be fully formed?
A
clavicle
21
Q
What bone connects the upper limb to the trunk?
A
clavicle (AC joint)
22
Q
T/F: The ulna doesn’t meet the wrist.
A
true; all forces received by the hand are transmitted from radius to ulna via interosseous membrane
23
Q
Surface anatomy: what landmarks are at the following spots
1) T2
2) T3
3) T7/ rib 8
A
1) superior angle @ T2
2) root of scapular spine (medial) @ T3
3) inferior angle @ T7/rib 8
24
Q
What four joints make up the upper extremity? What types of joints are they?
A
1) sternoclavicular (synovial, saddle)
2) acromioclavicular (synovial, plane)
3) scapulothoracic (physiological joint, not real)
4) glenohumeral (synovial, ball and socket)
25
What are the three ligaments involved in the sternoclavicular joint?
anterior sternoclavicular joint, interclavicular joint, and costoclavicular joint
26
What are the two divisions of the coracoclavicular ligament, and which one is medial?
```
trapezoid ligament (lateral)
conoid ligament (medial)
```
27
What is the only true joint between the upper extremity and axial skeleton?
sternoclavicular joint
28
When a clavicle moves up and down, where does most motion occur? When it protracts and retracts, where does most movement occur?
1) between the clavicle and the disk (for elevation and depression)
2) between the disk and the sternum
29
Where does the costoclavicular ligament specifically attach, and when is it taut?
- attaches to first rib and costal tubercle on the clavicle
| - taut when arm elevated or shoulder is protracted (so when clavicle would be up)
30
T/F: The sternoclavicular joint is very stable.
true, because of all the ligaments and the way the bones articulate
31
Where are you most likely to fracture your clavicle?
the weak middle portion
32
What ligament(s) resist(s) vertical displacement of clavicle?
- coracoclavicular ligament: trapezoid and conoid portions
| - this means it resists upward movement
33
T/F: The conoid portion of the coracoclavicular ligament allows for some rotation.
true, need this for arm elevation
34
When we abduct/elevate our arm, what happens to the clavicle?
it rotates backwards a bit on the sternum
35
What ligaments resist upward movement of the clavicle?
coracoclavicular ligament, costoclavicular ligament, sternoclavicular ligament
36
What ligament is taut when the clavicle is depressed?
interclavicular ligament
37
What ligament prevents upward rotation of the clavicle?
anterior sternoclavicular ligament
38
Movement of the pectoral girdle involves what three joints?
sternoclavicular, acromioclavicular, and glenohumeral joints
39
How many degrees of abduction are allowed without movement of the scapula?
30 degrees
40
When the arm is fully elevated at 180 degrees, how much is the scapula's doing and how much is the humerus?
60 degrees rotation of scapula, 120 degrees of rotation of humerus at shoulder joint (more movement in the humerus)
41
Which muscles are active in fist clenching?
extensor carpi radialis longus (ECRL) and extensor carpi ulnaris (ECU)
42
If the spinal accessory nerve is damaged, what impairment follows?
(trap and sternocleidomastoid) ipsilateral weakness when the shoulders are elevated against resistance
43
What impairment follows a dorsal scapular nerve injury?
(rhomboids and levator scapulae) scapula is farther from midline, weak retraction of scapula
44
What muscles/areas does suprascapular nerve innervate?
supraspinatus, infraspinatus, GH and AC joint capsules
45
What impairment results from a torn suprascapular nerve?
weak external rotation at the GH joint
46
If a patient is struggling with adduction and internal rotation of their arm, what muscles do you suspect aren't firing? What nerve(s) are the cause of this?
pec major and minor, with the medial and lateral pectoral n. potentially injured
47
A winging scapula indicates damage to what nerve?
long thoracic, innervates the serratus anterior
48
What can happen when the nerve to subclavius is injured?
you lose the subclavius muscle innervation, so clavicle can become unstabilized
49
What muscle does the upper subscapular n. innervate?
superior subscapularis
50
What muscle does the lower subscapular n. innervate?
inferior subscapularis and the teres major
51
What nerve innervates teres major?
lower subscapular nerve
52
If a patient is unable to raise their trunk with their upper limbs, what nerve may be damaged?
(latissimus dorsi), thoracodorsal nerve
53
What nerve pierces through the pronator teres?
median
54
What nerve forms the anterior interosseous nerve?
median
55
What nerve forms the posterior interosseous nerve?
radial
56
What motion does the acromioclavicular ligament limit?
posterior translation of clavicle
57
What is the function of the labrum?
holds the humeral head in the glenoid cavity; increases the surface area of the glenoid cavity for more contact with the head
58
What is the most injured rotator cuff muscle? Why?
Supraspinatous, because there's such little room where it's tendon is coming out that it can get rubbed and pinched
59
What ligaments prevent anterior translation of the humerus?
the glenohumeral ligament, all parts
60
T/F: Baseball players tend to have excessive external rotation going on.
false, internal rotation
61
If the labrum is torn, what can also be affected? Why?
the biceps brachii because its insertion is 50% on tubercle, 50% on the superior labrum; have to make sure your patient is cleared for bicep activities
62
What is found in the supraspinatus outlet?
supraspinatus tendon, artery, and nerve
63
What is the purpose of a bursa?
to reduce friction
64
What's the biggest external rotator of the rotator cuff?
infraspinatus
65
What does the coracohumeral ligament do?
strengthens the superior aspect of the joint, prevents humeral head from hanging down (same as SGHL)
66
What is the axillary recess?
pouch created by the inferior GH ligament; humeral head moves into here during elevation
67
10-15% of people are missing which GH ligament?
middle glenohumeral ligament
68
Which glenohumeral ligament is the thickest?
inferior GH ligament
69
What is the purpose of the rotator cuff?
stabilizes the GH joint
70
What is the main blood supply to the GH area and muscles?
post/anterior humeral circumflex a.'s, suprascapular a.
71
What is scapular dyskinesia?
When scapula doesn't move along thoracic wall like it should
72
What are the boundaries of the axillary artery divisions?
first part begins at 1st rib, ends at superior pec minor
second part is posterior to pec minor
third part is from inferior pec minor to teres major
73
What are the two divisions of the axillary artery in the second part?
thoracoacromial and lateral thoracic
74
Scapular circumflex a. anastemoses with what other artery?
suprascapular a., a branch off of subclavian a.
75
The roots of the brachial plexus can be compressed by what muscles up in the neck? How could they get tight?
anterior and middle scalenes; poor posture
76
What can an extra cervical rib do?
cause brachial plexus symptoms; tingling down arm
77
At what point does the subclavian become the axillary artery? At what point does axillary become brachial?
1st rib and teres major
78
What are the three trunks of the brachial plexus?
superior, middle, inferior
79
What are the supraclavicular branches of the brachial plexus? (4)
suprascapular n., NTS, dorsal scapular n., long thoracic n.
80
The lateral cord supplies what group of muscles?
flexors
81
The posterior cord supplies what group of muscles?
extensors
82
The medial cord supplies what group of muscles?
flexors
83
What does the axillary nerve supply?
deltoid and teres minor
84
What's the largest nerve off of the brachial plexus?
radial
85
What nerve courses through the dorsum of the hand?
superficial branch of radial
86
What injuries cause the waiter's tip presentation?
injury to roots of C5-6, so axillary, musculocutaneous, and suprascapular nerves
87
If the humerus fractures, what nerve is succeptible to damage?
radial nerve
88
What muscles are innervated by musculocutaneous?
biceps brachii, coracobrachialis, brachialis
89
What is Erb's palsy?
can result from that waiter's tip position caused during childbirth tear of C5-6
90
What is suprascapular neuropathy?
caused by compression/traction of suprascapular nerve at either the notch or spinoglenoid region
91
What are common signs of suprascapular neuropathy?
posterior shoulder pain, muscle weakness, atrophy
92
What artery passes through the scalenes along with the roots of the brachial plexus?
subclavian artery
93
What nerve is injured in claw hand? What happens in claw hand?
ulnar; MCP hyperextended, IPs flexed; smooth flexion pattern is lost when grabbing objects
94
What are the three superficial veins?
cephalic, basilic, and median cubital
95
Musculocutaneus n. pierces through what muscle?
coracobrachialis
96
What vein is in the deltopectoral triangle?
cephalic
97
The transverse humeral ligament that holds down the long head of the bicep is a combination of what three things?
subscapular tendon, coracohumeral ligament, and superior glenohumeral ligament (which are parts of the rotator cuff, so rotator cuff injuries could injure bicep)
98
What's in the quadrangular space?
posterior humeral circumflex a., and axillary artery
99
What are the boundaries of the triangular space?
teres minor, major, and long head of the tricep
100
What nerve supplies teres major?
lower subscapular n.
101
Which head of the triceps is the workhorse? Which head is the strongest?
medial; lateral
102
Volkman's contracture leads to ischemia to where?
ischemia to the posterior arm caused by a humeral fracture; this causes deep brachial a. to be severed, leading to pain and loss of power; claw hand can result
103
The tendon of the subscapularis helps form what structure?
the transverse humeral ligament
104
Which muscle is very weak after rotator cuff surgery or total shoulder arthroplasty?
subscapularis because they cut into that to get into the joint
105
What RTC repair issues should be taken into consideration?
size of tear, type of tear, tissue quality (diabetes), age (older tissue), type of surgical repair
106
Strengthening what muscle can help fix a rounded shoulder?
pec minor
107
Will you get glenohumeral extension if the radial nerve is cut high?
no
108
What muscle does the median nerve pierce?
pronator teres
109
What muscle can compress the ulnar?
flexor carpi ulnaris
110
The axillary artery becomes the brachial artery at what marker?
inferior teres major
111
The bicep tendon is tapped in the cubital fossa for test for the function of what nerve root?
C6
112
The tricep tendon is tapped to test for the function of what nerve root?
C8
113
What 3 nerves are injured in the waiter's tip presentation?
axillary, musculocutaneous, suprascapular
114
What's an example of an injury to the inferior parts of the brachial plexus?
clawhand: C8-T1
115
How does an infant with waiter's tip present?
- internally rotated: external rotators from suprascapular n.(infra and supra) and axillary (teres minor) are gone
- extended: flexors from musculocutaneus are gone
- adducted: abductor from suprascapular n. (supra) is gone
116
When can the axillary nerve be compressed? What muscles would suffer?
while using crutches; delt and teres minor
117
What is teres major innervated by?
lower subscapular n.
118
How does clawhand present?
extended MP and flexed IPs (ulnar nerve injury)
119
What are the two compression sites for the suprascapular nerve?
under the transverse scapular ligament or the spinoglenoid region
120
When can the long head of the biceps be a depressor?
during extreme external rotation
121
What is all in the cubital fossa? (5)
1. biceps tendon
2. brachial artery
3. median nerve
4. radial nerve
5. MABC (from brachial plexus) and LABC (from musculocutaneus)
122
What is the covering of the cubital fossa?
aponeurosis of bicep
123
What's the floor of the cubital fossa?
brachialis and supinator; radial artery and scaphoid
124
What do the collateral branches of the brachial artery supply? What about the nutrient branches?
collateral branches = supply elbow jt
| nutrient branches = supply humerus
125
What's the carrying angle of the elbow and what does it allow?
17.8 degrees, allows for your arm to swing alongside your trunk
126
The capitulum articulates with what?
head of the radius
127
The radial collateral ligament connects what to what?
lateral epicondyle to head of radius, blending with the annular ligament
128
With what kind of motion is the RCL stressed?
VERRIS motion (moving forearm toward trunk)
129
The ulnar collateral ligament connects what to what?
medial epicondyle to coronoid and olecranon; has three bands
130
Which of the three bands of the UCL is the strongest? The weakest?
anterior; posterior
131
Which motion stresses the UCL?
VALGUS motion (moving forearm away from trunk)
132
What does the annular ligament of the elbow do?
wrap around the head of the radius, supports proximal radioulnar joint
133
What is Cooper's ligament?
the transverse bundle of the UCL
134
What is pronator syndrome?
When the pronator teres is too tight, maybe from repetitive motion, causing the median nerve to be compressed
135
What makes up the cubital tunnel and what goes through it?
MCL and arcuate ligament; ulnar nerve passes through here and goes through FCU
136
What nerve supplies the brachioradialis?
Radial
137
What kind of joint is the radiocarpal joint?
condyloid joint w/ synovial membrane
138
At what joint does pronation/supination occur?
distal radioulnar joint
139
What is the primary stabilizer of the radioulnar joint?
triangular fibrocartilage complex (gymnasts and hockey players tear this with falls)`
140
Radial carpal collateral ligament connects what to what?
radius to scaphoid
141
Ulnar carpal collateral ligament connects what to what?
ulna to triquetrum
142
What do the vincula do?
blood supply to the tendons; connect tendons to anterior surface of phalange
143
How is carpal tunnel caused?
repetitive movements tighten the flexor retinaculum, compressing the median nerve
144
What do the synovial sheaths on the extensor side of the hand do?
help reduce friction on tendons
145
What is the purpose of the flexor retinaculum?
holds down tendons for efficient biomechanics on fingers
146
What is the purpose of the palmar aponeurosis?
- separates the hand into compartments; thumb, medial, lateral
- also protects tiny hand muscles/vessels
147
If the hand is infected on the lateral side, will it likely spread to the medial side?
NO because the palmar aponeurosis separates the hand into compartments, making them distinct and separate
148
What artery makes up the superficial palmar arch?
ulnar a.
149
The pisohamate ligament is also known as what?
tunnel of guyon, where ulnar n. and a. pass under
150
Lumbricals insert on what tendon?
flexor digitorum profundus, so they have the same innervation (half ulnar, half median)
151
What is the innervation of the flexor pollicis brevis?
deep head = ulnar
| superficial head = median
152
What is the innervation of the adductor pollicis?
ulnar
