Chapter 7 - Upper Extremity Flashcards
Only bone connecting the UE & axial skeleton
clavicle
Shoulder joints
acromioclavicular, sternoclavicular, glenohumeral, scapulothoracic (pseudo-joint)
4 muscles of the rotator cuff
SITS (supraspinatus, infraspinatus, teres minor, subscapularis)
supraspinatus action
abduction of arm
infraspinatus action
external rotation of arm
teres minor action
external rotation of arm
subscapularis action
internal rotation of arm
Deltoid action
primary flexor (Ant) & abductor (middle) & primary extensor (Post)
Latissimus dorsi action
Extensor & Adductor
Teres major action
Extensor
Pectoralis major action
Adductor
Subclavian a. passes b/w which muscles?
anterior & middle scalenes
Subclavian v. passes
anterior to the anterior sclene
Subclavian a. becomes the _____________ at the ______________
Axillary a. at the lateral border of the first rib
Axillary a. becomes the _____________ at the ______________
brachial a. at the inferior border of the teres minor mm
1st major branch of the brachial a.?
profunda brachial a.
profunda brachial a. accompanies which nerve?
radial n. as it passes posteriorly
Brachial a. divides into _________&___________ at the
ulnar a. & radial a. at the bicipital aponeurosis
Which artery supplies the lateral forearm & forms the deep palmar arterial arch?
Radial a.
Which artery supplies the medial forearm & forms the superficial palmar arterial arch?
Ulnar a.
OMT for lymph congestion of UE
thoracic inlet, re-dome diaphragm, & posterior axillary fold
Surgical neck of humerus fracture -> inability to abduct arm from 15-90 -> which nerve is injured?
Axillary n.
Which branch of the median n. supplies the thenar eminence?
recurrent branch of median n.
Median n. injury causes
carpal tunnel syndrome, lunate dislocation, supracondylar fracture of the humerus
Distal median claw hand would look like
on opening hand, pts 2-3 digits remain flexed (d/t loss of lateral lumbricals)
Proximal median claw hand would look like
inability to flex digits 1-3, while digits 4-5 are flexed (d/t loss of forearm flexors & lateral lumbricals)
Carpal Tunnel Syndrome
overuse of Flexor Retinaculum -> median n. entrapment
Causes of Carpal Tunnel Syndrome
“MEDIAN TRAP”
Myxedema, Edema, Diabetes, Idiopathic, Acromegaly, Neoplasm, Trauma, RA, Amyloidosis, Pregnancy
Radial n. injury causes
fracture to the body of the humerus, compression of nerve in axilla (Saturday night palsy), improper use of crutches -> wrist drop
Ulnar n. injury causes
medial epicondyle injury & hook of hamate fracture
Ulnar n. injury results in
the inability to abduct/adduct fingers, hypothenar eminence atrophy (on opening hand, digits 4-5 remain flexed d/t loss of median lumbricals)
How can you tell the difference b/w ulnar n. injury & a proximal median n. injury
ability to flex thumb - proximal median n. injury cannot flex thumb
Erb Duchenne Palsy
Lesion to C5-C6 (Upper trunk) - Most common brachial plexus injury; pulling superiorly on arm
Normal abduction of arm: ____ degrees
180
The normal 180 degree abduction, _____________ is accountable for 120 degrees
glenohumeral joint
The normal 180 degree abduction, _____________ is accountable for 60 degrees
scapulothoracic motion
Most common SD of the shoulder
restriction of IR/ER
2nd most common SD of the shoulder
restriction of abduction
Lest common SD of the shoulder
restriction of extension
Most common SD of sternoclavicular joint
anterior/superior clavicle on the sternum
Motion of the clavicle
the ends move in opposite directions & rotation around transverse axis
Most common SD of acromioclavicular joint
superior/lateral clavicle on the acromion
superior/lateral clavicle on the acromion - findings
“Step off” at AC joint
Ligaments of the acromioclavicular joint
acromioclavicular, coracoacromial, coracoclavicular ligaments
Thoracic Outlet Syndrome
compression of the subclavian a./v. & brachial plexus
Thoracic Outlet Syndrome - Compression occurs in what 3 places
b/w anterior & middle scaliness, b/w clavicle & rib 1, b/w pec minor & upper ribs
Thoracic Outlet Syndrome - S/S
neck pain radiating down arm, paresthesias, +Adsons
Supraspinatus tendinitis
impingement of the greater tuberosity against the acromion when arm is flexed + IR
Supraspinatus tendinitis - S/S
pain exacerbated by abduction, esp 60-120 “painful arc” may lead to calcification of mm
Bicipital tenosynovitis
inflammation of tendon & sheath of biceps long head d/t overuse, physiologic wear/tear, causing adhesions to bind tendon to bicipital groove
Bicipital tenosynovitis - S/S
anterior shoulder pain radiating to biceps + worsens w/ resisted flexion & supination
Rotator cuff tear
tear at insertion of 1 of the rotator cuff tendons
Rotator cuff tear - most common tendon torn
supraspinatus
supraspinatus tear - S/S
weakness in abduction +Droparm test, atrophy
Adhesive Capsulitis
pain & restriction of shoulder motion that worsens over a year
Adhesive Capsulitis - S/S
decreased ROM, extension is typically preserved
Adhesive Capsulitis etiology
prolonged immobility
What nerve is most commonly injured in shoulder dislocations?
Axillary n
Shoulder dislocations most commonly occur in which direction
Anterior & inferior dislocations
What nerve injury can cause winging of the scapula?
Long thoracic n. injury -> serratus anterior weakness
Erb-Duchenne palsy results in paralysis to which mm?
deltoid, external rotators, biceps, brachioradialis, supinators
Klumpke’s palsy
C8-T1 lesions -> paralysis of intrinsic mm of the hand
List the Carpal bones starting from the lateral side
Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capate, Hamate
Most flexors of the wrist/hand originate from _______________ & are innervated by ___________
Medial epicondyle; Median n.
Most extensors of the wrist/hand originate from _______________ & are innervated by ___________
Lateral epicondyle; Radial n.
Supinators of the forearm
biceps (musculocutaneous n) & supinator (radial n)
Pronators of the forearm
pronator teres & pronator quadratus (median n)
Innervation to hypothenar eminence
ulnar n.
Innervation to thenar eminence
median n.
Innervation to 1-2 lumbricals
median n.
Innervation to 3-4 lumbricals
ulnar n.
Flexor digitorum profundus attaches to
DIPs
Flexor digitorum superficialis attaches to
PIPs
Normal carrying angle for males
5 degrees
Normal carrying angle for females
10-15
Carrying angle >15 is
abduction of the ulna (cubitus valgus)
Carrying angle < 3 is
adduction of the ulna (cubitus varus)
Abducted ulna will cause what motion at the wrist
adduction of the wrist
Adducted ulna will cause what motion at the wrist
abduction of the wrist
Radial head glides ______ with forearm supination
anterior
Radial head glides ______ with forearm pronation
posterior
Posterior radial head causes
falling forward on a pronated forearm
Anterior radial head causes
falling Backward on a supinated forearm
Carpal Tunnel Syndrome S/S
paresthesia of thumb & first 2.5 digits, +Tinels, +Phalen
Lateral epicondylitis
“Tennis elbow” - overuse of extensors & supinators
Medial epicondylitis
“Golfer’s elbow” - overuse of flexors & pronators
Swan Neck Deformity
MCP/PIP/DIP = Flexed/Extended/Flexed d/t contracture of intrinsic mm of the hand
Boutonniere Deformity
MCP/PIP/DIP = Extended/Flexed/Extended d/t rupture of hood of the extensor tendon at PIP
Swan Neck Deformity & Boutonniere Deformity are associated w/
RA
Claw hand
MCP/PIP/DIP = Extended/Flexed/Flexed d/t median or ulnar n injury
Ape hand
Claw hand + thenar atrophy & thumb adduction d/t median n injury
Bishops deformity
contraction of the last 2 digits d/t ulnar n injury
Dupuytren’s Contracture
MCP/PIP flexion contracture seen w/ flexion of the last 2 digits d/t contracture of the palmar fascia
Drop-wrist deformity
radial n injury -> paralysis of extensor m.
Which nerve only carries fibers from C5 root?
Dorsal scapular n.
