Clinical Correlations of the Upper Limb Flashcards
dermatomes of upper limb
C4 - T3
cervical plexus
brachial plexus
intercostal nerve
GSA
pain fiber (exteroreceptive)
comes to dorsal root ganglia to dorsal root
angina pectoris
radiation of pain from thorax down left upper limb
-pain fibers assiciated with sympathetics T1-T4
T1 - T3 dermatomes of upper limb
visceral afferent interpretation present on skin
C345?
subdiaphragmatic irritaiton due to peritonitis, gall bladder inflammation, hepatic abscess, pleurisy, or accumulation of CO2 following laser surgery
pain at tip of shoulder
-phrenic nerve C345, supraclavicular nerve C34
p’eau d’orange
skin of orange
-dimpling of breast skin bc of tightening of suspensory ligaments
outward sign of tumor growth
dupuytrens contracture
thickening/contraction of longitudinal connective tissue bundles of palmar aponeurosis
draws fingers into palm
subacromial/subdeltoid bursitis
inflammation accompanied by pain and swelling within confined synovial space
-bursa surrounding glenohumeral or shoulder joint
olecranon bursitis
same as subacromial but in elbow
ganglion cyst
same as dupuytren for thendon sheaths of extensor surface of wrist
synovial inflammation
under extensor retinaculum
dequervains disease
inflammation of synovial sheath surrounding extensor pollicis brevis and abductor pollicis longus tendons
lots of trouble using thumb**
tenosynovitis - inflammation of tendon and synovial
trigger finger
same as olecranon bursitis but for flexor tendon sheaths in hand
axilla pathology?
stretching of cords of brachial plexus
- humeral dislocation
- tumor (pancoast or lymphoma)
compression of axillary artery
-stop bleeding distally, location of neoplastic lymph nodes toe to breast carcinoma metastasis
cubital fossa contents?
biceps tendon, brachial artery, median nerve
-lateral to medial
pathology of cubital fossa?
care during venapuncture
carpal tunnel
bound by flexor retinaculum
has 9 tendons and 1 nerve
carpal tunnel syndrome
irritation and inflammation in carpal fluid
-lots of pressure on median nerve
radial bursa
flexor pollicis longus sheath
ulnar bursa
common flexor
palmar aponeurosis
different septa branch down to carpal bone to define the compartments
midpalmar and thenar space
between the top compartments of hand and the adductor-interosseous compartment
clavicle
last bone to completely ossify
-strut for all of shoulder
used in autopsy to determine age
most commonly broken bond in body?
clavicle
-will often greenstick
medial clavicular dislocation
pressure on carotid sheath
- vagus nerve damage also possible
- stimulation can result in decrease in heart rate and contractility (heart PS innervation)
AC separation?
acromioclavicular separation
-strongest are conoid and trapezoid
grading of AC separation
1 - stretched AC ligaments
2 - tear AC, CC intact
3 - torn AC and CC, 3-5x increase in coracoclavicular distance
4/5 - samea s 3 with increased coracoclavicular distance
6 - complete rupture of both ligaments with inferior clavicular displacement
adhesive capsulitis
frozen shoulder
- thickened fibrotic, inflamed and shrunken capsule
- decreased ROM all range, ACTIVE and PASSIVE
- arthritis, bursitis, tendonitis, inactivity, postsurgical complications
get scapular motion
-not glenohumeral
rotator cuff
traverse majority of GH capsule en rough to humeral attachments
what is most often injured of rotator cuff?
supraspinatus
torn while trying to life too much or catching a heavy falling object through repetitive overhead motion activities
calcific tendonitis
erosion and inflammation of supraspinatus via osteophyte growth in AC joint
-tendon becomes calcified (less elastic) and more brittle
posterior glenohumeral dislocation
5% dislocations
posterior prominence of humeral head
-prominent coracoid process
-arm held in adduction with inability to laterally rotate humerus
anterior glenohumeral dislocation
95% of dislocations
loww of normal shoulder contour
muscles pull head of humerus into axilla, humerus slightly abducted
humeral head prominent anteriorly
symptoms - paresthesia in distribution of axilalry and musculocutaneous nerves
humero-ulnar dislocation
movement of ulna and radius posteriorly relative to humerus, may be associated with fractures
radial head subluxation
distal movement of radial head from undercover of annular ligament of the radius
-occurs more often in children - suddenly lifted
youth - fall on outstretched hand?
displacement of distal radial epiphysis
adolescent fall on outstretched hand
clavicular fracture
elderly fall on outstretched hand?
colle’ fracture
colle’s fracture
fracture of distal radius approximately 1 inch proxmial to radiocarpal joint, prsents silver fork deformity
most often fractured carpal bone?
scaphoid
-avascular necrosis
most often dislocated carpal bone?
lunate bone
-can impinge on carpal tunnel
if you put pressure on digit 3?
lunate dislocation
game-keepers thumb
rupture of ulnar collateral ligament
-of metacarpophalangeal joint of thumb
compression at axillary artery?
proximal humerus, medial surface
compression of brachial artery?
medial to anterior humerus from above downward
compression of ulnar artery?
distal anterior wrist lateral to pisiform
compression of radial artery?
distal anterior radius, snuff box, 1st dorsal digital space
avascular necrosis of scaphoid bone
non-union of distal fragment of scaphoid with proximal fragment
-distal portion contains nutrient artery entrance site and therefore, fracture may leave proximal fragment without a blood supply
raynauds syndrome
increased sympathetic innervation to distal blood vessels results in increased vasoconstruction with concomitant decrease in vascular flow
fingertips are cold and limb warm proximal
danger lies in necrosis in fingers
cervicodorsla preganglionic sympathectomy can be performed
superficial veins?
access for venapuncture, transfusion, catheterization
deep veins
thrombosis - clot in deep vein
-trauma, fracture, deep contusion
lymphangitis
inflammation of lymph vessels
-visible as red streaks
those which extend proximally from thumb and index finger follow course of cephalic vein to inferior clavicular nodes
those which originate in the medial three fingers follow the course of the basilic vein to cubital and lateral axillary lymph nodes
lymphadenitis
inflammation of lymph nodes
breast lymphatics
75 % lateral to nodes axillary (can palpate)
25% to parasternal nodes (deep) cannot palpate
contralateral drainage?
between the breasts
biceps tendon reflexes
biceps C56
triceps tendon reflexes
biceps C78
erb-duchennes palsy
injury to C5 C6 and nerve roots or upper trunk due to traction on neck
loss of flexors of forearm and lateral rotators of humerus
medial rotation takes over - limb held in waiters tip location
klumpkes palsy
injury to C8 T1 nerve roots of lower trunk
catch in hanging position while falling
results in total claw hand
-no balance between extensor and flexor muscles (lumbrical and interossei)
long thoracic nerve injury?
serratus anterior innervation
C567
results in winged scapula
- decreased ability to fully abduct limb
- loss of integrity of platform of upper limb from which it operates
axillary nerve damage
C56
injury to nerve as it passes around quadrangular space
poor crutch placement, downward glenohumeral dislocation, fracture of surgical neck of humerus
radial nerve damage
C5-T1
injury can occur as it exits axilla or winds around spiral groove
due to poor crutch placement, falling asleep with arm over back of chair, fracture of upper humerus
results in WRIST DROP
loss causes flexion contractures
innervation of triceps?
happens before the radial gets to the radial groove
therefore, damage to the radial groove won’t cause decreased in triceps innervation
musculocutaneous nerve damage?
C567
rarely injured
-loss of forearm flexion and supination, loss of cutaneous sensation to lateral forearm
median nerve damage
C678 T1, sometimes C5
injuries at elbow due to medial supracondylar humeral fracture
results in ape hand - decreased wrist flexion, supination, thumb neutral, wasting thenar eminence
carpal tunnel syndrome
inflammation impinges median nerve
-paresthesia lateral 3.5 fingers
paresis
wasting of thenar eminence
ulnar nerve nerve
C8 T1
injury within canal of struthers
occurs posterior to medial humeral epicondyle
-symptoms - weakness upon flexion and adduction of wrist with paresthesia to ring and little finger
injury in struthers canal
posterior to medial humeral epicondyle
injury in guyons tunnel
at wrist medial to flexor retinaculum beneath pisohamate ligament
cuts or falls on outstretched palms
major contributor to hand?
ulnar nerve
ulnar claw
partial ulnar claw - 4 5 digits
partial median claw
digits 2 and 3
ulnar nerve lesion?
need to pinch
frohments sign
if you pinch grab instead of adduct grab with thumb
-indicates ulnar nerve damage
