Clinical Correlations of the Upper Limb Flashcards
what is the purpose of dermatome testing?
to determine the integrity of ascending neuronal system
how does referred pain occur?
increase of somatic pain signals causes brain to misinterpret pain as coming from a specifically mapped cutaneous portion (angina pectoris)
what is the dimpling of the skin overlying the beast due to?
tightening of the suspensory ligaments via tumor growth, ect. P’eau d’orange
what pathologically thickens and tightens to cause Dupuytren’s contracture?
the longitudinal bundles of the palmar aponeurosis - draws fingers into palm to such degree that they become useless.
what is compressed during subacromial/subdeltoid bursitis?
supraspinatus tendon - inflammation accompanied by pain and swelling within the confined synovial space surrounding the glenohumeral or shoulder joint
what is a ganglion cyst?
excess fluid accumulation within the tendon sheath at the extensor surface of the wrist.
what is inflammation of the synovial sheath surrounding the extensor pollicis brevis and abductor policis longus tendon?
DeQuervain’s disease
why is the finger stuck in Trigger Finger?
node forms w/in tendon sheath preventing extension (cant fit through fibrous sheath
what bone is the most commonly broken bone in the body?
clavicle - “green stick” fracture
why is a medial clavicular dislocation particularly dangerous?
can result in pressure placed on the carotid sheath and compromise the arterial supply, impede venous return, and pinch the vagus n (CN X)
what involves stretching and/or rupture of acromioclavicular and coracoclavicular ligaments?
acromioclavicular (AC) separation
what is the lowest grade of AC separation involve?
stretching of AC ligaments
what is a grad 3 AC separation?
AC and CC ligaments are torn leading to complete separation
what is adhesive capsulitis?
frozen shoulder - thickened, fibrotic, inflamed and shrunken capsule resulting in decreased ROM. (due to a lot of things)
what is the most commonly injured rotator cuff muscle?
supraspinatus because of overtop position of tendon
why does the shoulder dislocate posteriorly only 5% of the time?
glenohumeral bands
what symptoms are associated with posterior dislocation of shoulder?
- posterior prominence of humeral head
- prominence of coracoid process
- arm held in adduction w/ inability to laterally rotate humerus
what are some symptoms associated with anterior dislocated shoulder?
- loss of normal shoulder contour
- humeral head prominence anteriorly (muscles pull head of humerus into the axilla)
- humerus slightly abducted
- sx include paresthesias in distribution of axillary and musculocutaneous nerves
what can be easily damaged within the cubital fossa through the trauma or improper use of needles?
(TAN) tendon of biceps, brachial artery, median nerve
what is inflammation of the synovial space of the elbow?
olecranon bursitis
inflammation and distension (w/ pus) of synovial tendon sheaths
tenosynovitis - inflammation of the radial (flexor pollicis longus sheath) and ulnar (common flexor) bursae
why can infection spread through the deep spaces of the palm?
because of the presence of deep palmer spaced formed by CT from the palmer aponerosis
what is erosion and inflammation of the supraspinatus tendon via osteophyes which grow down from the inferior surface of the AC joint?
calcific tendionosis of the supraspinatus tendon
as it passes around the elbow, the ulnar nerve passes through what fibro-osseous canal?
Struther’s canal
what can be easily stretched and damaged with a humero-ulnar dislocation?
ulnar nerve (but lots of other things as well)
occurs often in children when they are suddenly jerked/lifted from the ground while the forearm is pronated?
radial head subluxation - radial head moves distally from undercover of annular ligament of radius
when falling on an outstretch hand, what is likely to be damaged depending on age?
youth -
adolescent -
elderly -
youth - fracture of distal radial epiphysis plate
adolescent - clavicular fracture
elderly - fracture to the distal radius proximal to the radiocarpal joint (Colles’ fracture)
what is the most often fractured carpal bone and is susceptible to avascular necrosis?
scaphoid bone
what is the most often dislocated carpal bone and can impinge on the carpal tunnel?
lunate bone
what ligament often is ruptured during ski accident
ulnar collateral ligament of the metacarpophalangeal joint of the thumb
where do a lot of collateral anastomoses exist?
scapular, elbow, hand
what arteries are often compressed during movement?
axillary - proximal humerus
brachial - elbow
ulnar - distal anterior wrist lateral to pisiform
radial - distal anterior radius
what portion of the scaphoid bone contains nutrient artery entrance site leading to necrosis if fracture occurs?
distal portion - proximal portion dies if fracture leaves fragment without blood supply (why important)
condition where there is increased sympathetic innervation to distal blood vessels leading to increased vasoconstriction with concomitant decrease in vascular flow?
raynaud’s disease
what characteristics allows access for surgical procedures like venapuncture, transfusion, and catheterization?
nature of superficial veins (close to the surface)
patient comes in with hand that was injured a couple weeks ago and is now inflamed and painful. patient has ‘red streaks’ coursing up arm from the hand and palpable nodes. what condition does the patient have in regards to lymphatic system?
lymphangitis and lymphadenitis
patient had decreased bicep reflex indicating problem with which nerves?
C5, C6
patient has decreased tricep reflex indicating problem with which nerves?
C7, C8
occurring after a fall, a patient is unable to move their right arm from a adducted and medially rotated position which places their hand behind. what does the patient have and what was injured leading to loss of what movements?
Erb-Duchenne’s palsy
- injury to C5, C6 (upper trunk of brachial plexus)
- loss of forearm flexors and lateral humeral rotators
- medial rotators take over and limb is held in “waiters tip” position
catching himself by grabbing a branch abruptly while falling several feet, a patient is unable to close his left hand and is stuck in a claw like position. what does the patient have and what was injured leading to loss of what?
Klumpke’s palsy
- injury to C8, T1 nerve roots or lower trunks
- loss of intrinsic muscles of hand
- “claw hand”
after being mugged, patient has contusion over lateral chest under axilla and has difficulty abduct arm and reach forward. what nerve was injured and what other sign with the patient present?
long thoracic nerve (C5,6,7) - “winged scapula”
what is often damaged with then humerus is fractured along its surgical neck? what would be the symptoms?
axillary nerve (C5,6)
- wasting of deltoid contour
- decreased abduction and flexion
- loss of cutaneous sensation over lower 1/2 of deltoid
what is often damaged when humerus is fractured distally toward the elbow? what are the symptoms?
radial nerve (C5-T1)
- runs through the spiral groove of the
- wrist drop (acute)
- flexion contracture (long term)
patient was in a tragic accident leading to rupture of coracobrachialis. can no longer flex or supinate his hand and loss sensation to lateral forearm. what was likely damaged?
musculocutaneous n (C5,6,7)
patient presents hand that has wasting of thenar eminence, decreased wrist flexion, and is supinated with the thumb in lateral position. what is the condition and what was likely injured?
“ape hand” - due to loss of forearm flexors, thumb abductor and flexor policis brevis, and 1/2 lumbricals.
Median nerve (C6-T1)
- will have “median claw”
patient cut palm at wrist medial to the flexor retinaculum deeply and now has paresthesias in ring and little finger, wasting of hypothenar eminence and tunneling. what tunnel and its contents was damaged? what else will be present?
Guyon’s tunnel - formed by the pisohamate ligament and contains the ulnar nerve (C8, T1)
- “ulnar claw”
- forment’s sign (loss of adduction of the thumb)
