Clinical Correlations

Question 1

What is dermatome testing

Answer 1

integrity of ascending neuronal system

Question 2

what are 2 examples of refferred pain

Answer 2

under diaphragm irritation causing pain tip of shoulder. from phrenis C3-5 and supraclavicular nn C3 C4
angina pectoris

Question 3

what is angina pectoris

Answer 3

radiation from thorax to upper left limb

sympathetic T1-T4 and T1-T3 are the dermatomes of upper limb

Question 4

P’eau d’orange

Answer 4

orange skin. dimpling of skin overlaying breast due to tightening of the suspensory ligaments-tumor growth

Question 5

Dupuytren’s contracture

Answer 5

pathological thickening and contracture of the longitudinal CT bundles of palmar aponeurosis. draws fingers into palm

Question 6

Subacromial/subdeltoid bursitis

Answer 6

inflammation accompanied by pain and swelling within a confined synovial space, in this case the bursa around glenhumeral joint

Question 7

olecranon bursitis

Answer 7

inflammation of elbow

Question 8

ganglion cyst

Answer 8

thickening and contracture of tendon sheaths at extensor surface of wrist

Question 9

DeQuervain’s disease

Answer 9

inflammation of the synovial sheath surrounding extensor pollicis brevis and abductor pollicis longus tendons

Question 10

Trigger finger

Answer 10

inflammation of flexor tendons of the hand

Question 11

clinical correlations go radial and ulnar bursae

Answer 11

tenosynovitis inflammation and distension of synovial tendon sheaths

Question 12

what could happen in the deep palmar spaces

Answer 12

spread of infection thorugh deep spaces

Question 13

What bone is used to determine age of badly decomposed bones

Answer 13

clavicle- last to ossify early 2nd-3rd decade

Question 14

what is the typical fracture of clavicle

Answer 14

in the middle because of natural curve. “green stick” fracture

Question 15

results of medial calvicular dislocation

Answer 15

pressure on carotid sheath. CNX= decrease HR and contractility

Question 16

AC separation

Answer 16

stretching or rupturing the acromioclavicular and coracoclavicular ligaments

Question 17

Grades of AC joint

Answer 17

1: stretch
2: torn AC stretch CC
3: torn AC CC and 3-5X increase of space
4/5: greater increase in separation
6: complete rupture of both ligaments with inferior clavicle displacement

Question 18

adhesive capsulitis

Answer 18

thickend fibrotic inflammed capsule decreasing all ROM active and passively

Question 19

what can cause adhesive capsulitis

Answer 19

arthritis, bursitis, tendonitis, inactivity, postsurgical complication

Question 20

scneario of tearing supraspinatus tendon

Answer 20

trying to lift too much or catchin heavy object.

Question 21

calcific tendinosis of supraspinatus tendon

Answer 21

osteophytes growing inferiorly from arthritic AC joint

tendon becomes calcific so less elastic and more brittle- prone to rupture

Question 22

What can cause a ruptured tendone of long head biceps

Answer 22

intracapsular tendon becomes inflammed and erodes over time

Question 23

what is bicipital tendonitis

Answer 23

inflammtion of the synovial sheath surrouding the tendon of the long head of the biceps within inter tubercular groove.
can lead to dislocation of long head biceps

Question 24

describe posterior shoulder dislocations

Answer 24

5% shoulder dislocations
posterior prominence of humeral head, prominent coracoid process and the arm is in adduction without being able to laterally rotate

Question 25

describe anterior shoulder dislocations

Answer 25

95% shoulder dislocations loss of normal contour pull head of humerus into axilla- slight abduction humeral head is prominent anteriorly Sx include paresthesias in distribution of axillary and musculocutaneous nn

Question 26

describe humero-ulnar dislocation

Answer 26

movement of ulna and radios posteriorly relative to the distal end of humerus- can stretch ulna n

Question 27

Radial head subluxation

Answer 27

distal movement of the radial head from undercover of the annular lig- children when yanked

Question 28

If a youth falls on outstretched hand what usually happens

Answer 28

dislocation of radial epiphysis

Question 29

if an adolescent falls on outstretched hand what usually happends

Answer 29

clavicular fracture

Question 30

if an elderly person falls on outstretched hand what usually happens

Answer 30

colles' fracture. distal radius fracture 1 in proximal to joint- "silver fork" deformity

Question 31

what carpal bones can be affected in falling on outstretched hand

Answer 31

scaphoid- most common | lunate- most often dislocated

Question 32

What is Game Keeper's or skiiers thumb

Answer 32

rupture of ulnar collateral log of metacarpophalangeal joint of thumb

Question 33

what arteries are in compression sites

Answer 33

axillary- proximal humerus medial surface brachial- medial to anterior humerus from above downward ulnar- distal anterior wrist lateral to pisiform radial- distal anterior radius "snuff box"

Question 34

what is avascular neccrosis of scaphoid bone

Answer 34

when distal and proximal scaphoid fracture apart. distal contains nutrient a import, so proximal has no blood supply

Question 35

Raynaud's syndrome

Answer 35

increased sympathetic inn to distal blood vessels causing increased vasoconstriction with concomitant decrease in vascular flow. fingertips coldest. can cause necrosis distally

Question 36

Tx for Raynauds' syndrome

Answer 36

cervicodorsal preganglionic sypathectomy- induce vasodilation

Question 37

how are superficial vv used clinically

Answer 37

access for surgical procedures: venapunctures, transfusions, cardiac catheterization

Question 38

what causes thrombosis

Answer 38

trauma, fracture or deep contusions. deep vein clot | spntaneous- reduced physical activity for prolonged time and weakened muscular fascia- weak musculovenous pump

Question 39

Lymphangitis

Answer 39

inflammation of lymph vessels "red streaks"

Question 40

lymphangitis that extend proximally from thumb and index finger go where

Answer 40

follow course of cephalic v to inferoir clavicular nodes

Question 41

lymphangitis that originate in medial 3 fingers follow course of what

Answer 41

basilic v to cubital and lateral axillary lymph nodes

Question 42

why do infections on fingers of palm lead to inflammatory edema or abcess on dorsume of hand

Answer 42

lymph drains to dorsum

Question 43

lymphadenitis

Answer 43

inflamed lymph nodes as a direct result of lymphangitis

Question 44

What segmental regions do the bicep and tricep tendon reflexes check

Answer 44

biceps: C5,C6 triceps: C7C8

Question 45

Erb-Duchenne's palsy

Answer 45

Injury to C5 C6 nerve roots or upper trunk to traction placed on neck (falling on shoulder) loss of flexors of forearm and lateral rotators of humerus medial rotators take over and the limb looks like waiter tip

Question 46

Klumpke's palsy

Answer 46

Injury to C8 T1 nerve roots or lower trunk; catching one's self in a hanging positions while falling loss of hand intrinsic mm claw hand- loss of lumbricals and interossei

Question 47

Damage to long thoracic n C5-C7 causes what

Answer 47

winged scapula because lose serratus anterior | lose scapular portion of abduction

Question 48

Where is axillary n usually damaged? what cord levels is this?

Answer 48

passes around humerus in quadrangular space. | C5 C6 C7

Question 49

what can cause axillary n damage and results in what?

Answer 49

poor crutch placement, downward glenohumeral dislocation, fracture of surgical neck of humerus results in wasting of deltoid contour, decreased abduction and flexion of arm loss of cutaneous sensation over lower 1/2 deltoid

Question 50

where is radial n usually damaged? What cord levels is this?

Answer 50

injury as it exits axilla or winds around humerus in the "spiral" groove C5-T1

Question 51

what can cause radial n damage?

Answer 51

poor crutch placement, falling asleep with arm over back of chair or fracture of upper humerus, downward dislocation of glenohumeral joint

Question 52

what are the Sx of acute and chronic radial n damage

Answer 52

acute: wrist drop- loss of all extensors chronic: flexion contractures of flexors of upper limb with complete loss of limb function

Question 53

what can cause musculocutaneous damage? and what levels?

Answer 53

traumatic rupture of coracobrachialis | C5 C6 C7

Question 54

what is the resulting injury of Musculocutaneous

Answer 54

loss of forearm flexion and supination; loss of cutaneous sensation to lateral forearm

Question 55

What are the 2 common syndromes involving MEdian N

Answer 55

ape hand and carpal tunnel

Question 56

What can cause ape hand

Answer 56

medial supracondylar humeral fracture or humeroulnar dislocation

Question 57

what is ape hand

Answer 57

appearance due to decreased wrist flexion, supination of hand(both pronators paralyzed), thumb in neutral position(laterally rotated and adducted) and wasting of thenar eminence

Question 58

what causes carpal tunnel syndrome

Answer 58

increased activity of wrist resulting in edema, compression and inflammation of median n

Question 59

Sx of carpal tunnel syndrome

Answer 59

paresthesias of lateral 3.5 fingers paresis upon flexion abduction and opposition of thumb wasting thenar eminence loss of fine motor control 2n3 and 3rd digits due to paralysis of 1st and 2nd lumbricals "median claw" loss of opposition and grasp reflex

Question 60

what can injure the recurrent branch of median n

Answer 60

falling on outstretched palm

Question 61

What n gets injured if the psterior medial humeral epicondyle is fractured or dislocated

Answer 61

canal of Struther's, Ulnar n C8 T1

Question 62

Sx of ulnar n damage from strutter canal compression

Answer 62

weakness during flexion and adduction of the wrist with paresthesias to ring and little finger

Question 63

Where is the guyon's tunnel

Answer 63

wrist medial to flexor retinaculum beneath pisohamate ligament

Question 64

what causes injury to ulnar n within guyons tunnel

Answer 64

falling on outstreched palms

Question 65

deficits seen with ulnar damage in guyon's canal

Answer 65

paresthesias to ring and little finger wasting of hypothenar eminence and interosseous spaces ulnar claw of 4th and 5th fingers loss of adduction of the thumb (Froment's sign)