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MSK exam 2 AP > clinical correlations of upper limb > Flashcards

clinical correlations of upper limb Flashcards

1
Q

intercostal cutaneous brachial nerves

A

T1-T3

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2
Q

referred pain angina pectoris

A

T1-4, T5

pain from the thorax down the left upper limb

dermatomes of the upper limb T1-T3

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3
Q

Dupuytren’s contracture

A

thickening and contracture of longitudinal connective tissue bundles of palmar aponeurosis

draws fingers into palm

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4
Q

subacromial/subdeltoid bursitis

A

inflammation accompanied by pain and swelling within a confined synovial space or bursa

decrease in the amount of fluid

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5
Q

Olecranon bursitis

A

inflammation of olecranon bursa

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6
Q

ganglion cyst

A

inflammation/cyst formation of tendon sheaths at the extensor surface

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7
Q

DeQuervains’ disease tenosynovitis (synovial and tendon inflammation)

A

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

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8
Q

Trigger finger

A

inflammation of synovial tendon sheaths of flexor tendon sheaths in the hand

finger doesn’t relax, stays in flexion

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9
Q

axilla problems

A

stretching of cords of the brachial plexus due to humeral dislocation

tumor

compression of the axillary artery to stop profuse bleeding distally

neoplastic lymph nodes due to breast carcinoma metastasis

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10
Q

Cubital fossa contents

A

Lateral to medial TAN

Tendons of biceps brachii
Brachial artery
Median nerve

improper use of needles can harm this area
trauma as well

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11
Q

radial (flexor pollicis longus sheath) and ulnar (common flexor) bursae

A

tenosynovitis

inflammation and distension of synovial tendon sheats

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12
Q

carpal tunnel

A

9 tendons

median nerve

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13
Q

deep palmar spaces

A

spread of infection through deep spaces of palm

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14
Q

clavicle ?

A

last bone to completely ossify (used in identifying skeletal remains to tell approximate age of individual)

most commonly broken

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15
Q

what happens with medial clavicular dislocation

A

results in pressure placed on the carotid sheath

this can lead to mechanical stimulation of cranial nerve 10 (vagus n) by the medial head of the clavicle this leads to decrease in heart rate and contractility since the vagus nerve innervates heart parasympathetically

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16
Q

acromioclavicular AC separation

A

involves stretching and or rupture of acromioclavicular and coracoclavicular ligaments

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17
Q

grade 1 AC separation

A

stretching AC ligaments

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18
Q

grade 2

A

torn AC ligaments with stretched CC ligament

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19
Q

grade 3

A

Torn AC and CC with 3-5 times increased coracoclavicular space

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20
Q

grade 4 and 5

A

even more increase in coracoclavicular space

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21
Q

grade 6 complete

A

complete rupture of both ligaments with inferior clavicular displacement

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22
Q

Frozen shoulder

A

Adhesive capsulitis

thickened, fibrotic, inflamed, shrunk capsule

scapular motion, no glenohumeral motion

shoulder doesn’t move (decreased) in all ranges of motion

can be from arthritis, bursitis, tendonitis, inactivity, postsurgical complication

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23
Q

supraspinatous tendon

A

most often injured rotator cuff muscle b/c its position

also suscpetible to erosion via osteocytes which grow down from arthritic AC joint

supraspinatous is the initiator of abduction

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24
Q

what are the causes of rotator cuff injuries

A

lift too much or catching a heavy falling object

repetitive overhead motion activities

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25
Q

calcific tendonitis of the supraspinatous tendon

A

erosion and inflammation of the suprspinatous tendon via osteophytes which grow down from the inferior surface of the AC joint

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26
Q

ruptured tendon of the long head of the biceps

A

intracapsular tendon becomes inflamed and erodes over time

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27
Q

bicipital tendinitis

A

inflammation of the synovial sheath surrounding the tendon of the long head of the biceps within the intertubercular groove

can lead to dislocation of the long head of the biceps from the groove

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28
Q

posterior shoulder dislocation

A

5 percent of dislocations

done by “sliding into second base”

greater tubercule and head of humerus prominent posterior
coroacoid process prominent anteriorly

cannot rotate humerus laterally

arm held in adduction

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29
Q

anterior shoulder dislocation

A

95 percent of shoulder dislocations

head of humerus prominent anteriorly, slides into axilla

parasthesias involved include axillary and musculocutaneous

lose the shoulder contour

humerus is slightly abducted

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30
Q

pinprick the proximal shoulder area near deltoid and the lateral forearm

A

testing the axillary and musculocutaneous (lateral antebrachial cutaneous)

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31
Q

humero-ulnar dislocation

A

movement of the radius and ulna posteriorly relative to the distal end of the humerus

ulnar n. may be stretched

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32
Q

radial head subluxation

A

“nursemaid”

distal movement of the radial head from undercover the annular ligament of the radius

occurs more often in children

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33
Q

fall on outstretched hand

A

youth
-displacement of distal radial epiphysis

adolescent
-clavicular fracture

adult
-Colle’s fracture

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34
Q

Colle’s fracture

A

fracture to the distal radius approximatley 1 inch proximal to the radiocarpal joint

causes “silver fork” deformity

dont’ set this properly you can end up with avascular necrosis of the scaphoid

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35
Q

scaphoid fracture

A

most often fractured carpal bone

deep to snuff box

36
Q

lunate problems??

A

most often dislocated carpal bone

can impinge carpal tunnel

force on the middle finger pushing down onto carpals

37
Q

Avascular necrosis of scaphoid bone

A

non-union of distal fragment of scaphoid with proximal fragment

distal portion contains nutrient artery entrance site and therefore fracture may leave the proximal fragment without a blood supply

38
Q

(Skier’s thumb) Game Keeper’s thumb

A

rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb

if you abduct the thumb passively then it just goes without resistance

39
Q

compression site of axillary artery

A

proximal humerus medial surface

40
Q

compression sites of brachial artery

A

medial to anterior humerus from above downward

41
Q

ulnar artery compression sites

A

distal anterior wrist lateral to pisiform

42
Q

radial artery compression sites

A

distal anterior radius “snuff” box

1st dorsal digital space

43
Q

what is the thoracocdorsal anastomed with ?

A

transverse cervical artery

44
Q

what does the suprascapular artery anastomose with

A

suprascapular artery anastomomes with circumflex scpaular artery

45
Q

what does the acromial branch of the thoracoacromial trunk anastomes with

A

the anterior circumflex humeral artery

46
Q

what if you have a blockage proximal to the thoracromial trunk ?

A

don’t anastome with anything??

47
Q

true or false

arteries have valves

A

false

they don’t have valves so they can redirect their flow

48
Q

what does the radial recurrent anastome with?

A

the radial collateral artery

49
Q

where are the perforating arteries sitting?

A

going from superficial to deep from palmar to dorsal

50
Q

Raynaud’s disease

A

increased sympathetic innervation to distal blood vessels
results in increased vasoconstriction with concomitant decrease in vascular flow

finger tips coldest- hand looks blue
anxiety and cold weather make this worse

danger lies in necrosis of fingers due to reduced perfusion

51
Q

how can you fix raynaud’s

A

cervicodorsal preganglionic sympathectomy can be performed to induce vasodilation

52
Q

deep thrombosis

A

clot formation within a vessel

can result from trauma (fracture, deep contusion)

spontaneous due to reduced physical activity or weakened muscular fascia resulting in diminshed musculovenous pump

53
Q

superficial veins

A 
cephalic vein (start on dorsal lateral surface of forearm) 
basilic vein (starts on dorsal medial surface of hand)

access for surgical procedures
venapuncture , transfusion

54
Q

lymphangitis

A

inflammation of lymph vessels

red streaks (visible as this)

those from thumb and index finger follow the course of the CEPHALIC vein to inferior clavicular nodes

those from the medial three fingers follow the course of the BASILIC vein to cubital and lateral axillary lymph nodes

55
Q

why do infections happen on dorsum of hand?

A

most lymph vessels from the fingers pass to the dorsum of the hand and then ascend the forearm

56
Q

lymphadenitis

A

inflamed lymph nodesas a direct result of lymphangitis

57
Q

breast lymph drainage

A

75 percent to axillary lymph nodes

25 percent is conducted to parasternal nodes which are internal to the thorax (more difficult to detect) paralleling the internal throacic artery

contralateral drainage exists between the breasts

58
Q

Tendons relfexes

A

test integrity of segmental regions of spinal cord

59
Q

biceps reflexes

A

C5, C6

60
Q

Triceps reflexes

A

C7, C8

61
Q

Erb-Duchenne’s palsy

A

injury to C5 and C6 at the brachial plexus level (deltoid, supraspinatous, infraspinatous, teres minor, biceps)
b/c bicep tone is decreased don’t have supination

injure by increase angle between head and shoulder

loss of flexors of the forearm and lateral rotators of the humerus

medial rotators take over, limb held in “waiter’s tip” position

62
Q

Klumpke’s palsy

A

C8 and T1 injury

loss of intrinsic muscle of the hand

CLAW HAND–> b/c C8 and T1 go to the hand
due to loss of muscle which provide balance between powerful extensor and flexor muscles of the fingers (lumbricals and interossi)

this injury is caused due to catching one’s self in a hanging position while falling

63
Q

Winged scapula

A

injury to long thoracic nerve

decreased ability to fully abduct the hand (decreased scapular rotation component)

loss of integrity of platform of upper limb from which to operate (loss of scapular fixation)

64
Q

Injury to axillary nerve

A

injury to nerve as it passes around humerus in quadrangular space

happens due to poor crutch placement , downward glenohumeral dislocation, fracture of surgical neck of humerus

axillary supplies deltoid and teres minor

wasting of the deltoid contour
decreased abduction and flexion of the arm

loss of cutaneous sensation over lower 1/2 of deltoid

65
Q

radial nerve injury

A

injury to nerve can occur as it exits the axilla or winds around the humerus in the “spiral groove”

all extensors are lost
wrist drop - acute
flexion contractures - chronic

66
Q

examples of how to injure the radial nerve

A

poor crutch placement

falling asleep with arm over back of chair

fracture of the upper humerus

downward dislocation of glenohumeral joint

67
Q

musculocutaneous nerve injury

A 
results in: 
flaccid flexor compartment
minimal flexion at the shoulder
no flexion at the elbow (loss of forearm flexion)
reduced supination

loss of cutaneous sensation to lateral forearm

68
Q

median nerve injury

A

slide 77

mostly flexor muscles

69
Q

ulnar nerve injury

A

slide 79

partial claw

ulnar nerve lesion have to use pincher and can’t use adduction griop

70
Q

what can an injury at the elbow due to medial supracondylar humeral fracture or numero-ulnar dislocation result in?

A

Ape Hand

-appearance due to decreased wrist flexion and supination of the hand (both pronators paralyzed)

thumb in neutral position (laterally rotated and adducted)

wasting of the thenar eminence

71
Q

wrist drop

A

happens due to injury of the radial nerve

ACUTE loss results in this due to loss of innervation of all extensors

72
Q

flexion contractures

A

chronic loss of radial nerve (secondary to injury) results in this type of flexion contractures of flexors of the upper limb with complete loss of limb function

73
Q

what are the cord levels of musculocutaneous

A

C5, C6, C7

74
Q

what are the cord levels of axillary

A

C5, C6

75
Q

what are the cord levels of Median nerve

A

C6-T1, sometimes C5

76
Q

how does carpal tunnel syndrome happen?

A

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

77
Q

symptoms of carpal tunnel (x5)

A

paresthesias of lateral 3 1/2 fingers

weakness upon flexion, abduction and opposition of thumb

wasting of thenar eminence

loss of fine motor control of 2nd and 3rd digits due to paralysis of 1st and 2nd lumbricals

loss of opposition; loss of grasp reflex

78
Q

median claw

A

can be from injury of median nerve

loss of fine motor control of 2nd and 3rd digitis due to paralysis of 1st and 2nd lumbricals

79
Q

what can falling on an outstretched hand potentially do?

A

injure the recurrent branch of the median nerve

80
Q

struther’s canal

A

look it up

81
Q

guyon’s tunnel

A

look it up

82
Q

Injury within the canal of struther’s

A

occurs posterior to the medial humeral epicondyle (fracture/dislocation)

symptoms include weakness upon flexion and adduction of the wrist with paresthesias to the ring and little finger

83
Q

injury within Guyon’s tunnel

A

occurs at the wrist medial to the flexor retinaculum beneath the pisohamate ligament (spans the hamulus of the hamate to the pisiform)

occurs as a result of cuts or falls on the outstretched palms

84
Q

deficits seen with injury that is within Guyon’s tunnel

A

paresthesias to the ring and little finger

wasting of the hypothenar eminence and interosseous spaces (tunneling)

ulnar claw appearance of hand (4th and 5th digits)

loss of adduction of the thumb (Froment’s sign- adductor pollicis)

85
Q

ulnar claw?

A

due to injury of the ulnar nerve (4th and 5th digits)

MSK exam 2 AP (7 decks)

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