Clinical Correlations Flashcards
What is dermatome testing
integrity of ascending neuronal system
what are 2 examples of refferred pain
under diaphragm irritation causing pain tip of shoulder. from phrenis C3-5 and supraclavicular nn C3 C4
angina pectoris
what is angina pectoris
radiation from thorax to upper left limb
sympathetic T1-T4 and T1-T3 are the dermatomes of upper limb
P’eau d’orange
orange skin. dimpling of skin overlaying breast due to tightening of the suspensory ligaments-tumor growth
Dupuytren’s contracture
pathological thickening and contracture of the longitudinal CT bundles of palmar aponeurosis. draws fingers into palm
Subacromial/subdeltoid bursitis
inflammation accompanied by pain and swelling within a confined synovial space, in this case the bursa around glenhumeral joint
olecranon bursitis
inflammation of elbow
ganglion cyst
thickening and contracture of tendon sheaths at extensor surface of wrist
DeQuervain’s disease
inflammation of the synovial sheath surrounding extensor pollicis brevis and abductor pollicis longus tendons
Trigger finger
inflammation of flexor tendons of the hand
clinical correlations go radial and ulnar bursae
tenosynovitis inflammation and distension of synovial tendon sheaths
what could happen in the deep palmar spaces
spread of infection thorugh deep spaces
What bone is used to determine age of badly decomposed bones
clavicle- last to ossify early 2nd-3rd decade
what is the typical fracture of clavicle
in the middle because of natural curve. “green stick” fracture
results of medial calvicular dislocation
pressure on carotid sheath. CNX= decrease HR and contractility
AC separation
stretching or rupturing the acromioclavicular and coracoclavicular ligaments
Grades of AC joint
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
adhesive capsulitis
thickend fibrotic inflammed capsule decreasing all ROM active and passively
what can cause adhesive capsulitis
arthritis, bursitis, tendonitis, inactivity, postsurgical complication
scneario of tearing supraspinatus tendon
trying to lift too much or catchin heavy object.
calcific tendinosis of supraspinatus tendon
osteophytes growing inferiorly from arthritic AC joint
tendon becomes calcific so less elastic and more brittle- prone to rupture
What can cause a ruptured tendone of long head biceps
intracapsular tendon becomes inflammed and erodes over time
what is bicipital tendonitis
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
describe posterior shoulder dislocations
5% shoulder dislocations
posterior prominence of humeral head, prominent coracoid process and the arm is in adduction without being able to laterally rotate
describe anterior shoulder dislocations
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
describe humero-ulnar dislocation
movement of ulna and radios posteriorly relative to the distal end of humerus- can stretch ulna n
Radial head subluxation
distal movement of the radial head from undercover of the annular lig- children when yanked
If a youth falls on outstretched hand what usually happens
dislocation of radial epiphysis
if an adolescent falls on outstretched hand what usually happends
clavicular fracture
if an elderly person falls on outstretched hand what usually happens
colles’ fracture. distal radius fracture 1 in proximal to joint- “silver fork” deformity
what carpal bones can be affected in falling on outstretched hand
scaphoid- most common
lunate- most often dislocated
What is Game Keeper’s or skiiers thumb
rupture of ulnar collateral log of metacarpophalangeal joint of thumb
what arteries are in compression sites
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”
what is avascular neccrosis of scaphoid bone
when distal and proximal scaphoid fracture apart. distal contains nutrient a import, so proximal has no blood supply
Raynaud’s syndrome
increased sympathetic inn to distal blood vessels causing increased vasoconstriction with concomitant decrease in vascular flow. fingertips coldest.
can cause necrosis distally
Tx for Raynauds’ syndrome
cervicodorsal preganglionic sypathectomy- induce vasodilation
how are superficial vv used clinically
access for surgical procedures: venapunctures, transfusions, cardiac catheterization
what causes thrombosis
trauma, fracture or deep contusions. deep vein clot
spntaneous- reduced physical activity for prolonged time and weakened muscular fascia- weak musculovenous pump
Lymphangitis
inflammation of lymph vessels “red streaks”
lymphangitis that extend proximally from thumb and index finger go where
follow course of cephalic v to inferoir clavicular nodes
lymphangitis that originate in medial 3 fingers follow course of what
basilic v to cubital and lateral axillary lymph nodes
why do infections on fingers of palm lead to inflammatory edema or abcess on dorsume of hand
lymph drains to dorsum
lymphadenitis
inflamed lymph nodes as a direct result of lymphangitis
What segmental regions do the bicep and tricep tendon reflexes check
biceps: C5,C6
triceps: C7C8
Erb-Duchenne’s palsy
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
Klumpke’s palsy
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
Damage to long thoracic n C5-C7 causes what
winged scapula because lose serratus anterior
lose scapular portion of abduction
Where is axillary n usually damaged? what cord levels is this?
passes around humerus in quadrangular space.
C5 C6 C7
what can cause axillary n damage and results in what?
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
where is radial n usually damaged? What cord levels is this?
injury as it exits axilla or winds around humerus in the “spiral” groove
C5-T1
what can cause radial n damage?
poor crutch placement, falling asleep with arm over back of chair or fracture of upper humerus, downward dislocation of glenohumeral joint
what are the Sx of acute and chronic radial n damage
acute: wrist drop- loss of all extensors
chronic: flexion contractures of flexors of upper limb with complete loss of limb function
what can cause musculocutaneous damage? and what levels?
traumatic rupture of coracobrachialis
C5 C6 C7
what is the resulting injury of Musculocutaneous
loss of forearm flexion and supination; loss of cutaneous sensation to lateral forearm
What are the 2 common syndromes involving MEdian N
ape hand and carpal tunnel
What can cause ape hand
medial supracondylar humeral fracture or humeroulnar dislocation
what is ape hand
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
what causes carpal tunnel syndrome
increased activity of wrist resulting in edema, compression and inflammation of median n
Sx of carpal tunnel syndrome
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
what can injure the recurrent branch of median n
falling on outstretched palm
What n gets injured if the psterior medial humeral epicondyle is fractured or dislocated
canal of Struther’s, Ulnar n C8 T1
Sx of ulnar n damage from strutter canal compression
weakness during flexion and adduction of the wrist with paresthesias to ring and little finger
Where is the guyon’s tunnel
wrist medial to flexor retinaculum beneath pisohamate ligament
what causes injury to ulnar n within guyons tunnel
falling on outstreched palms
deficits seen with ulnar damage in guyon’s canal
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)
