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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
calcific tendonitis of the supraspinatous tendon
erosion and inflammation of the suprspinatous tendon via osteophytes which grow down from the inferior surface of the AC joint
26
ruptured tendon of the long head of the biceps
intracapsular tendon becomes inflamed and erodes over time
27
bicipital tendinitis
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
28
posterior shoulder dislocation
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
29
anterior shoulder dislocation
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
30
pinprick the proximal shoulder area near deltoid and the lateral forearm
testing the axillary and musculocutaneous (lateral antebrachial cutaneous)
31
humero-ulnar dislocation
movement of the radius and ulna posteriorly relative to the distal end of the humerus ulnar n. may be stretched
32
radial head subluxation
"nursemaid" distal movement of the radial head from undercover the annular ligament of the radius occurs more often in children
33
fall on outstretched hand
youth -displacement of distal radial epiphysis adolescent -clavicular fracture adult -Colle's fracture
34
Colle's fracture
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
35
scaphoid fracture
most often fractured carpal bone deep to snuff box
36
lunate problems??
most often dislocated carpal bone can impinge carpal tunnel force on the middle finger pushing down onto carpals
37
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 the proximal fragment without a blood supply
38
(Skier's thumb) Game Keeper's thumb
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
compression site of axillary artery
proximal humerus medial surface
40
compression sites of brachial artery
medial to anterior humerus from above downward
41
ulnar artery compression sites
distal anterior wrist lateral to pisiform
42
radial artery compression sites
distal anterior radius "snuff" box | 1st dorsal digital space
43
what is the thoracocdorsal anastomed with ?
transverse cervical artery
44
what does the suprascapular artery anastomose with
suprascapular artery anastomomes with circumflex scpaular artery
45
what does the acromial branch of the thoracoacromial trunk anastomes with
the anterior circumflex humeral artery
46
what if you have a blockage proximal to the thoracromial trunk ?
don't anastome with anything??
47
true or false | arteries have valves
false | they don't have valves so they can redirect their flow
48
what does the radial recurrent anastome with?
the radial collateral artery
49
where are the perforating arteries sitting?
going from superficial to deep from palmar to dorsal
50
Raynaud's disease
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
how can you fix raynaud's
cervicodorsal preganglionic sympathectomy can be performed to induce vasodilation
52
deep thrombosis
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
superficial veins
``` 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
lymphangitis
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
why do infections happen on dorsum of hand?
most lymph vessels from the fingers pass to the dorsum of the hand and then ascend the forearm
56
lymphadenitis
inflamed lymph nodesas a direct result of lymphangitis
57
breast lymph drainage
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
Tendons relfexes
test integrity of segmental regions of spinal cord
59
biceps reflexes
C5, C6
60
Triceps reflexes
C7, C8
61
Erb-Duchenne's palsy
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
Klumpke's palsy
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
Winged scapula
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
Injury to axillary nerve
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
radial nerve injury
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
examples of how to injure the radial nerve
poor crutch placement falling asleep with arm over back of chair fracture of the upper humerus downward dislocation of glenohumeral joint
67
musculocutaneous nerve injury
``` 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
median nerve injury
slide 77 | mostly flexor muscles
69
ulnar nerve injury
slide 79 partial claw ulnar nerve lesion have to use pincher and can't use adduction griop
70
what can an injury at the elbow due to medial supracondylar humeral fracture or numero-ulnar dislocation result in?
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
wrist drop
happens due to injury of the radial nerve ACUTE loss results in this due to loss of innervation of all extensors
72
flexion contractures
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
what are the cord levels of musculocutaneous
C5, C6, C7
74
what are the cord levels of axillary
C5, C6
75
what are the cord levels of Median nerve
C6-T1, sometimes C5
76
how does carpal tunnel syndrome happen?
Increased activity of wrist resulting in edema, compression and inflammation of median n.
77
symptoms of carpal tunnel (x5)
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
median claw
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
what can falling on an outstretched hand potentially do?
injure the recurrent branch of the median nerve
80
struther's canal
look it up
81
guyon's tunnel
look it up
82
Injury within the canal of struther's
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
injury within Guyon's tunnel
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
deficits seen with injury that is within Guyon's tunnel
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
ulnar claw?
due to injury of the ulnar nerve (4th and 5th digits)

MSK exam 2 AP (7 decks)

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