Clinical Cases Flashcards
The typical sight of fracture of clavicle is –
Middle third
The typical injury at the medial end of clavicle is a – or – dislocation of Sternoclavicular joint
Anterior or posterior
Posterior dislocation of clavicle may have impact on what structures?
Impinge on the great vessels of the superior mediastinum and compress or disrupt them
In the glenohumeral joint – dislocation occurs most frequently
Anterior
Clinically all anterior dislocations are –
Anteroinferior
In an anterioinferior dislocation the ________ nerve maybe injured by direct compression of the humeral head on it and the ________ nerves maybe affected due to the lengthening effects of the humerus producing _______ disorder
Axillary
Radial nerve, radial nerve paralysis
__________________ dislocations of the Glenn humeral joint is rare and its causes include ____________.
Posterior
Epileptic seizure due to electrocution
The two main disorders of the rotator cuff are – and –
Impingement and tendinopathy
Of the four muscles that form the rotator cuff the blood supply to – tendon is relatively poor
Supraspinatous tendon
The accessory nerve can be evaluated by testing the function of trapezius muscle. how is this generally done?
By asking patients to shrug their shoulders against resistance.
Explain the quadrangular space syndrome.
Hyper trophy of the quadrangular space muscles or fibrosis of the muscle edges impinge on the axillary nerve. uncommonly, this produces weakness of the deltoid muscle. Typically, it produces atrophy of the terrace minor muscle, which may affect the control that the rotator cuff muscles exert upon shoulder movement.
A tap on tendon of biceps brachii at the elbow is predominantly used to test what?
C6 segment of spinal cord
A tap on the tendon of triceps brachii is used to test which nerve?
C7
Low BP may be caused by _______ , ____________ or ___________.
High blood loss
Infection
Myocardial infarction
Explain how sphygmomanometer is used to measure BP
The sphygmomanometer is a device that inflates a cuff around the mid portion of the arm to compress the brachial artery against the humerus. The cuff is inflated so that it exceeds the normal systolic BP. the clinician places a stethoscope over the brachial artery in the cubital fossa and auscultates for the pulse. as the pressure in the arm cuff of the sphygmomanometer reduces just below the normal systolic blood pressure the thumping sound of the blood becomes audible. As the pressure further drops the thumping sound becomes clearer. once the pressure drops below the diastolic BP the thumping becomes inaudible. so using a range of when the thumping first became audible to when it becomes last audible, the patient’s BP is determined.
Low BP may be caused by _______ , ____________ or ___________.
High blood loss
Infection
Myocardial infarction
Explain how sphygmomanometer is used to measure BP
The sphygmomanometer is a device that inflates a cuff around the mid portion of the arm to compress the brachial artery against the humerus. The cuff is inflated so that it exceeds the normal systolic BP. the clinician places a stethoscope over the brachial artery in the cubital fossa and auscultates for the pulse. as the pressure in the arm cuff of the sphygmomanometer reduces just below the normal systolic blood pressure the thumping sound of the blood becomes audible. As the pressure further drops the thumping sound becomes clearer. once the pressure drops below the diastolic BP the thumping becomes inaudible. so using a range of when the thumping first became audible to when it becomes last audible, the patient’s BP is determined.
The fracture in the mid-shaft of the humerus is most likely to damage _____________ nerve of the arm. What are the symptoms that the patient exhibits if this nerve is damaged?
A fracture in the mid-shaft of the humerus is most likely to damage the radial nerve of the arm. This injury is typical and the nerve should always be tested when such a fracture is reported. The patient’s symptoms usually include wrist drop and sensory changes over the dorsum of the hand.
In the arm and forearm, the median nerve is usually not injured by trauma. Why?
Because of its relatively deep position.
The most common neurological problem associated with the medial nerve is _____________.
Compression beneath the flexor retinaculum at the wrist (carpal tunnel syndrome).
Explain the carpal tunnel syndrome and its clinical significance.
On very rare occasions, a fibrous band may arise from the anterior aspect of the humerus beneath which the median nerve passes. This is an embryological remnant of the coracobrachialis muscle and is sometimes called the ligament or Struthers. Occasionally this ligament may calcify causing the compression of the median nerve and the subsequent weakness of the flexor muscles of the forearm and thenar muscles. Nerve conduction studies will demonstrate the site of nerve compression
When a fracture or soft tissue trauma suspected in the elbow joint, what are the tests that the patient is subjected to?
Plain lateral and AP radiograph
When a fracture or soft tissue trauma suspected in the elbow joint, what are the tests that the patient is subjected to?
Plain lateral and AP radiograph
What is pulled elbow disorder? How is it treated?
Pulled elbow is a disorder that typically occurs in children under 5 years of age. It is commonly caused by a sharp pull of the child’s hand, usually when the child is pulled up a curb. The not-yet-developed head of the radius and the laxity of the anular ligament of radius allow the head to sublux from this cuff of tissue. Pulled elbow is extremely painful, but can be treated easily by simple supination and compression of the elbow joint by the clinician. When the radial head is relocated the pain subsides immediately and the child can continue with normal activity.
Epicondylitis in tennis players:
Epicondylitis in golf players:
Tennis players:- pain occurs I;lateral epicondyle and common extensor origin
Golf players:- medial epicondyle and common flexor origin
Monteggia’s fracture
Fracture of the proximal 1/3rd of ulna and anterior dislocation of head of radius
Galeazzi’s fracture
Fracture of distal 1/3rd of the radius and subluxation (partial dislocation) of the head of ulna(distal part of ulna is called the head of ulna)
Colles’ fracture
Fracture + posterior displacement of distal end of radius
