Clinical Correlations- Upper Limb

Question 1

surgical neck radius fracture

Answer 1

axillary nerve endangered

Question 2

midshaft humerus fracture

Answer 2

radial nerve endangered

Question 3

dislocation of shoulder

Answer 3

anterior/inferior dislocation

endangers axillary and musculocutaneous nerve

Question 4

elbow dislocation

Answer 4

fall on outstretched hand
occurs posteriorly
endangers median and ulnar nerves
may be accompanied by fracture

Question 5

Colle’s fracture

Answer 5

fracture of distal radius, usually from FOOSH

distal fragment is forced proximally and dorsally

Question 6

scaphoid fracture

Answer 6

most commonly fractured carpal
in anatomic snuff box
can result in avascular necrosis if not caught

Question 7

rotator cuff muscle most susceptible to injury

Answer 7

supraspinatus

rubbing on acromion and coracoacromial ligament

Question 8

musculocutaneous nerve compression

Answer 8

weakness of elbow flexion, numbness of lateral forearm

Question 9

Cubital tunnel syndrome

Answer 9

ulnar nerve compression as it passes through the 2 heads of flexor carpi ulnaris

Question 10

posterior compartment neuropathy

Answer 10

compression of deep branch of radial nerve as it passes through the supinator
weakened extension of wrist and fingers

Question 11

tennis elbow

Answer 11

pain over lateral epicondyle

due to overexertion of brachioradialis

Question 12

Erb’s palsy

Answer 12

upper plexus injury (C5, C6)
head pulled away from shoulder
wrist drop, loss of elbow flexion, supination, hand extensors, lateral sensation
waiters tip deformity

Question 13

Klumpke’s palsy

Answer 13

lower plexus injury (C8, T1)
muscles of forearm and hand
arm forcefully pulled up and away from shoulder
claw-hand, ring and pinky fingers most affected
weak grasp due to loss of flexion

Question 14

Saturday night palsy

Answer 14

direct compression of radial nerve onto shaft of humerus

weakened elbow, wrist, finger extension, supination

Question 15

Wrist drop

Answer 15

forearm extensor muscle affected

radial nerve injury

Question 16

Median nerve injury

Answer 16

affects wrist and finger flexion, ability to use thumb, index, and middle fingers

Question 17

Ulnar nerve injury

Answer 17

claw hand
inability to effectively use the ring and little finger
loss of abduction and adduction of 2nd to 5th digits

Question 18

Test nerve sensation cutaneously- radial

Answer 18

dorsal web space between thumb and finger

Question 19

Test nerve sensation cutaneously- median

Answer 19

palmar aspect of tip of index finger

Question 20

Test nerve sensation cutaneously- ulnar

Answer 20

palmar aspect of tip of little finger

Question 21

SLAP lesion

Answer 21

superior labrum anterior to posterior
via throwing (pitcher's shoulder)

Question 22

Little leaguer’s shoulder

Answer 22

growth plate behind head of humerus fractures

Question 23

subclavius function

Answer 23

protects brachial plexus in clavicle fracture

can affect roots/trunks

Question 24

winged scapula

Answer 24

loss of serratus anterior due to long thoracic nerve injury
inability to fully abduct arm
mastectomy, heavy load

Question 25

test function of axillary nerve

Answer 25

Sergeant's patch sensation

Question 26

Popeye deformity

Answer 26

tear in long head of the biceps

Question 27

Median nerve test

Answer 27

test palmar cutaneous branch of median nerve if there is sensation: problem is compression within the tunnel

Question 28

Scaphoid fracture

Answer 28

most common carpal bone fracture avascular osteonecrosis caused by FOOSH

Question 29

skiier's thumb

Answer 29

rupture of ulnar collateral ligament

Question 30

carpal tunnel syndrome

Answer 30

atrophy of thenar eminence look for sensation in palm inability to oppose thumb adduction is still in tact

Question 31

Ulnar nerve lesion

Answer 31

claw hand- hyperextension of MCP joint because lumbricals and interossei that flex are not functioning wrist flexion, deviates radially if flexor carpi ulnaris is out

Question 32

Radial nerve lesion

Answer 32

wrist drop | sensory deficit in dorsum of hand and forearm

Question 33

Anterior interosseous syndrome

Answer 33

check OK sign, lack of innervation to pronator quadrates, flexor pollicis longs, flexor digitorum profundus

Question 34

powerful knee extension

Answer 34

last 10-15 degrees of extension is very powerful due to patellar tendon insertion on tibial tuberosity

Question 35

causes of carpal tunnel

Answer 35

``` acromegaly rheumatoid arthritis myxoedema (hypothyroid) idiopathic trauma ARMPIT ```

Question 36

consequences of carpal tunnel

Answer 36

``` paresthesia (tingling) hypoesthesia (decreased sensation) anesthesia muscle weakness atrophy of thenar eminence ```

Question 37

test for radial nerve damage cutaneously

Answer 37

1st dorsal webspace on hand

Question 38

denervation: long thoracic

Answer 38

inability to reach forward (winged scapula)

Question 39

denervation: axillary

Answer 39

inability to abduct shoulder | surgical neck of humerus fracture

Question 40

denervation: radial

Answer 40

inability to extend forearm | weakened arm extension

Question 41

strong medial rotators

Answer 41

subscapularis pectorals major trees major latissimus dorsi

Question 42

rotator cuff muscles

Answer 42

supraspinatus infraspinatus teres minor subscapularis

Question 43

adductors of arm

Answer 43

teres major

Question 44

arm flexors

Answer 44

biceps brachii, coracobrachialis