Clinical Anatomy Flashcards
A patient comes to see you complaining of pain in their posterior forearm when lifting a glass to drink or opening a door. What test would you do to confirm the likely diagnosis?
The extended finger resistance test. Production of pain towards the elbow when you press on an extended middle finger is indicative of lateral epicondylitis…or tennis elbow.
A volleyball player went to block a shot and jammed her finger. You examine her and she cannot extend the distal joint of her finger. What does she have?
Mallet finger. This is when you rupture the DIP extensor tendon.
A skateboarder slips off his board and lands on his elbow. What muscle and bone were likely involved in him “breaking” his elbow?
A flexed triceps with the tendon pulling on the olecranon.
What symptoms might be manifested in someone with a synovial ganglion cyst in the dorsum of their hand?
That similar to carpal tunnel syndrome because cysts often form near the carpal tunnel and can compress the median nerve.
A construction worker was cut with a circular saw below his elbow. What nerves contribute to him making the sign of benediction when asked to make a fist? What other clinical sign might he have?
The median nerve was severed which supplies the PIP of digits 1-3 and the DIP/MCPs of 2 & 3. Flexion of 4 & 5 remain unaffected because these are innervated by the ulnar nerve which was apparently not injured in the accident. You would also expect to see an abnormal “pinch” sign when asked to make an “OK” sign with the index and thumb because the anterior interosseous nerve is a branch off of the median nerve and innervates the flexor digitorum profundus and flexor pollicus longus.
A football player comes to see you after a biceps curl competition with decreased sensation on the volar side of fingers 1-3. You rule out carpal tunnel syndrome first. What do you do next to figure out what’s going on?
Test pronation strength and see if you can reproduce symptoms when resistance is applied upon pronation (flexion of the pronator teres). Median nerve compression by the pronator teres near the elbow is likely causing his symptoms.
What are the four common places to injure your ulnar nerve?
1.) Posterior to the medial epicondyle 2.) In the cubital tunnel (formed by the tendinous arch connecting the humeral and ulnar heads to the flexor carpi ulnaris 3.) Wrist 4.) Hand
You are a concert pianist and suffer an injury to the distal portion of your forearm. What nerve do you pray is not injured and why?
Ulnar nerve. Injury results in atrophy of interosseous muscles and “claw hand” due to unopposed action of extensors and FDP. Adduction of the wrist is impaired. The wrist is drawn medially when attempted to flex because the FCU no longer counterbalances the FCR. MCP joints become hyperextended because flexor tone is lost and you can no longer flex fingers 4 & 5. Finally the interphalangeal joints cannot extend.
An IV drug abuser comes to your clinic complaining of pain and weakness in his hand. You think he might have injured a nerve as he cannot extend his thumb or the MCP joints of the other fingers. What nerve may have been injured as a result of IV drug abuse?
He probably hit the deep radial nerve that supplies the MCP joints via the extensor digitorum.
You do a clinical test and diagnose a patient with DeQuervian Tenosynovitis. What tendons are inflammed in this patient?
The abductor pollicus longus and extensor pollicus brevis
Why in carpal tunnel do patients normally continue to have palmar sensation?
The palmar cutaneous branch of the median nerve does not pass through the carpal tunnel.
Why do people progressively lose strength in their thumb in carpal tunnel syndrome?
The median nerve supplies the abductor pollicus brevis and opponens pollicis.
What is the flexor retinaculum released on the medial side of the wrist in carpal tunnel release procedures?
In order to avoid damage to the recurrent branch of the medial nerve which is on the lateral portion of the hand.
If a person injured their median nerve by trying to commit suicide by slitting their wrist, will they still have a functional thumb if they survive?
Partially. The abductor pollicus longus and adductor pollicus can still move the thumb because they are supplied by the ulnar nerve.
Your patient tells you they have lost sensation on the medial part of their hands after riding their bike across the country. What has caused these symptoms?
Riding for a long time with your hands extended puts pressure on the hamate hooks which compresses the ulnar nerves.
A person comes to see you after a long day of skiing complaining of minimal strength in their thumb when grabbing things and turning the key of their car. What likely happened when he was skiing?
He ruptured the collateral ligament of the 1st MCP joint. This usually is a result of hyperabduction of the MCP joint of the thumb.
After being in a car accident a patient had lacerations in her forearm. She did not lose any motor function, only sensation to the dorsum of her hand. What nerve was injured and why was motor function unimpaired?
She injured the superficial branch of the radial nerve. This branches off from the radial nerve as does the posterior interosseous nerve which supplies suppinator and extensor function to the forearm. She still has function because the posterior interosseous nerve is still functioning.
Why is a streptococcus infection in the forearm an urgent condition?
The bacteria can cause huge amounts of damage as it travels up the fascial compartments of the forearm.
Your friend fell on an outstretched hand and denotes pain in his anatomical snuffbox. What portion of this broken bone is least likely to heal well?
The proximal portion of the scaphoid. It receives blood supply distally to proximally by the distal recurrent radial artery.
What type of shoulder dislocation is a quarterback most likely to get?
Anterior. When throwing the shoulder is abducted and externally rotated. Getting hit from behind can push the head of the humerus anterio-inferiorly and dislocate the shoulder.
What elbow injury is common in kids while being swung by their parents as they walk? How is this fixed?
Subluxation and dislocation of the radial head. This occurs when the radius is pulled on while the arm is pronated and the distal annular ligament is torn. The radius is put back into place by suppinating the child’s arm while flexed at the elbow.
A person slips on ice and falls on an outstretched hand. They did not break their scaphoid. What is the most common forearm fracture?
Colles fracture. It is a complete fracture of the distal 2cm of the radius.
A patient has been having problems with flexion of his hand. What muscles would you beef up to help him with this action?
Interossei (MCP joint flexion), Flexor Digitorum Superficialis (PIP joint flexion), Flexor Digitorum Profundus (DIP joint flexion), Thenar (Thumb MCP joint flexion), and the Flexor Pollicus Longus (Thumb PIP joint flexion).
A patient has been having problems with extension of his hand. What muscles would you beef up to help him with this action?
Extensor Digitorum Communis (MPC joint extension), Interossei (PIP and DIP joint extension), Extensor Pollicus Brevis (Thumb MPC joint extension), and the Extensor Pollicus Longus (Thumb PIP joint extension).
What muscles of the hand can act in flexion and extension?
Interossei and Thenar muscles.
Will a nerve injury involving the posterior portion of the supinator cause more or less damage than a nerve injury involving the anterior portion of the supinator?
Less. The nerve enters the anterior portion of the supinator and exits on the posterior portion.
Why would you think that the trapezium may have originally been a metacarpal?
The growth plate of the metacarpal of the thumb is located proximally where all of the other finger metacarpals are located distally with the phalynx metacarpals located proximally.
What kind of motion do you have when extending the wrist?
Radio-carpal and lunato-capitate motion
What causes the scaphoid to commonly break at the waist when someone falls on an outstretched hand?
Radioscaphoid capitate ligament
A patient comes to see you with a broken pinky and ring finger. She says she will still probably be okay to do all normal activities because these are the smaller fingers of the hand. Is she right?
No. The pinky and the thumb are the most flexible fingers of the hand and allow for grabbing of things.
A patient is having difficulty flexing his finger but has not torn any tendons. What else could be torn that make it difficult for him to flex his fingers?
The annular ligaments around the intermediate and proximal phalanges. These make up the pulleys necessary for finger flexion.
What muscles are atrophied when you diagnose a carpal tunnel patient with thenar atrophy?
Abductor pollicis brevis, flexor pollicis brevis and opponens pollicis.
What muscles are atrophied when you diagnose someone with hypothenar atrophy?
Abductor digiti minimi, flexor digiti minimi brevis and opponens digiti minimi
When you pinch your girlfriend what muscles are making her squeal?
Adductor pollicis and 1st dorsal interosseus muscle
What deep muscles of the hand abduct the fingers? Adduct?
DAB (dorsal interossei) and PAD (palmar interossei)
A patient is having trouble with flexion of all finger joints. What muscles are weak at each joint?
DIPJ = FDP, PIPJ = FDS, MPJ = IO
A patient is having trouble with extension of all finger joints. What muscles are weak at each joint?
DIPJ = IO, PIPJ = IO/EDC, MPJ = EDC (extensor digitorum communis)
Why can you also get a patient’s pulse on the dorsal side of the hand?
The radial artery dives into the anatomical snuffbox deep to the tendons as it forms the radial side of the deep palmar arch.
What arteries would you tie off most proximal to your incision if you cut the superficial palmar arch?
The ulnar and radial arteries. These form the superficial palmar arch. Note the ulnar artery will be most superficial.
What major muscles will still work if someone has a cut to the ulnar nerve?
Abductor pollicus brevis (median), flexor pollicis brevis (median), opponens pollicus (median) and the radial side of the 1st three lumbricals (median).
During a routine exam of your patient you notice that one leg is longer than the other. What could this condition be called if it was due to the hip?
Coxa vara = if the angle between femur shaft and head has decrease and shortened the leg. Coxa valga - if the angle between femur shaft and head has increased and lenthened the leg.
A wide receiver jumps up to receive a pass and gets hit with a helmet right in the hip on the way down. The trainer says he has a hip pointer. What happened to him to cause this pain?
The impact probably ruptured capillaries in the sartoriius when it was compressed on the anterior superior iliac spine (ASIS)…forming a contusion.
A man comes to see you with a “pulled groin” after horseback riding. What muscle was likely pulled?
His adductor longus. This muscle remains flexed throughout most of the duration of a horseback ride to keep the rider from falling off.
Your cardiologist says he wants to do an angiogram to look at your left heart. Through what vessel will he go through? What if he wanted to look at your right heart?
Femoral artery = left heart. Femoral vein = right heart
You are bleeding profusely after a gunshot wound to the anterior thigh. Where should the medic put pressure to control your bleeding?
It is possible that the bullet ruptured the profunda femoral artery. In this case, you need to compress the femoral artery by compressing it on the psoas major and superior pubic ramus.
A 45 year old female comes to see you for a tender bump inferior and lateral to the pubic tubercle. You diagnose her with a femoral hernia. What path did the intestine have to take to get into the femoral triangle where it could bulge out?
It had to pass into the femoral ring, through the femoral canal and out the saphenous opening where it is now bulging outwards.
