Clinical notes

Question 1

The strong costoclavicular ligament firmly holds the

Answer 1

medial end of the clavicle to the 1st costal cartilage

Question 2

the reason why dislocation of the sternoclavicular joint takes place occasionally

Answer 2

because of the presence of the strong costoclavicular ligament firmly holds the medial end of the clavicle to the 1st costal cartilage

Question 3

results in the medial end of the c icle projecting forward beneath the skin; it may also be pulled upward

Answer 3

Anterior dislocation

Question 4

Anterior dislocation

medial end of the clavicle may also be pulled upward by the

Answer 4

sternocleidomastoid muscle.

Question 5

This dislocation follows direct trauma applied to the front of the joint that drives the clavicle backward

Answer 5

Posterior dislocation

Question 6

why is the posterior dislocation of the sternoclavicular joint more serious

Answer 6

because the displaced clavicle may press on the trachea, the esophagus, and major blood vessels in the root of the neck

Question 7

if this ligament ruptures completely, it is difficult to maintain the normal position of the clavicle once reduction has been accomplished
(easily redislocates)

Answer 7

costoclavicular ligament

Question 8

The plane of the articular surfaces of the acromioclavicular joint passes_______

Answer 8

downward and medially

Question 9

The strength of the acromioclavicular joint depends on the

Answer 9

strong coracoclavicular ligament

Question 10

The plane of the articular surfaces of the acromioclavicular joint passes downward and medially so that there is a tendency for the lateral end of the clavicle to

Answer 10

ride up over the upper surface of the acromion

Question 11

binds the coracoid process to the undersurface of the lateral part of the clavicle

Answer 11

strong coracoclavicular ligament

Question 12

greater part of the weight of the upper limb is transmitted to the clavicle through this ligament, and rotary movements of the scapula occur at this important ligament

Answer 12

strong coracoclavicular ligament

Question 13

A severe blow on the point of the shoulder, as is incurred during blocking or tackling in football or any severe fall, can result in the

Answer 13

acromion being thrust beneath the lateral end of the clavicle, tearing the coracoclavicular ligament.

Question 14

tearing the coracoclavicular ligament due to trauma This condition is known as

Answer 14

shoulder separation

Question 15

shoulder separation
The displaced outer end of the clavicle is easily palpable. As in the case of the sternoclavicular joint, the dislocation is easily reduced, but withdrawal of support results in

Answer 15

immediate redislocation

Question 16

what factors contribute to the instability of the shoulder joint

Answer 16

The shallowness of the glenoid fossa of the scapula and the lack of support provided by weak ligaments

Question 17

strength of the shoulder joint depends on the

Answer 17

tone of the short muscles (subscapularis in front, the supraspinatus above, and the infraspinatus and teres minor behind)

Question 18

what forms the rotator cuff

Answer 18

tendons of the short muscles that bind the upper end of the humerus to the scapule
anterior - subscrapularis
superior- supraspinatus
posterior - infraspinatus, teres minor
no muscular support inferiorly

Question 19

least supported part of the joint

Answer 19

inferior location, where it is unprotected by muscles.

Question 20

is the most commonly dislocated large joint

Answer 20

shoulder joint

Question 21

Sudden violence applied to the humerus with the joint fully abducted tilts the humeral head downward onto the inferior weak part of the capsule, which tears, and the humeral head comes to lie inferior to the glenoid fossa

Answer 21

Anterior Inferior Dislocation

Question 22

Anterior Inferior Dislocation

The strong flexors and adductors of the shoulder joint now usually pull the humeral head forward and upward into the

Answer 22

subcoracoid position

Question 23

what muscles will pull the head of the humerus forward and upward into the subcoracoid position
in an Anterior Inferior Dislocation

Answer 23

strong flexors and adductors of the shoulder joint

Question 24

quadrangular space boundaries

Answer 24

superior - subscapularis, capsule of the shoulder joint

inferior - teres major m.

medial - long head of triceps

lateral - surgical neck of humerus

Question 25

what are the contents of the quadrangular space

Answer 25

axillary nerve | posterior circumflex humeral vessels

Question 26

Posterior dislocations are rare and are usually caused by

Answer 26

direct violence to the front of the joint

Question 27

this landmark is important in identifying posterior shoulder dislocation

Answer 27

greater tuberosity of the humerus, which will no longer bulge laterally beneath the deltoid muscle - rounded appearance of the shoulder

Question 28

this type of displacement of the head of the humerus into the quadrangular space can cause damage to the axillary nerve

Answer 28

subglenoid displacement

Question 29

subglenoid displacement of the head of the humerus into the quadrangular space can cause

Answer 29

damage to the axillary nerve, as indicated by paralysis of the deltoid muscle and loss of skin sensation over the lower half of the deltoid

Question 30

this nerve can be damaged by downward displacement of humerus

Answer 30

radial nerve and axillary nerve

Question 31

The synovial membrane, capsule, and ligaments of the shoulder joint are innervated by the

Answer 31

axillary nerve and the suprascapular nerve

Question 32

the shoulder joint is

Answer 32

sensitive to pain, pressure, excessive traction, and distention

Question 33

The muscles surrounding the shoulder joint undergo reflex spasm in response to pain originating in the joint, which in turn leads to

Answer 33

immobilize the joint and thus reduce the pain, and atrophy (disuse)

Question 34

Injury to the shoulder joint is followed by

Answer 34

pain, limitation of movement, and muscle atrophy owing to disuse.

Question 35

what other diseases can cause shoulder pain

Answer 35

diseases of the spinal cord and vertebral column and the pressure of a cervical rib can cause shoulder pain Irritation of the diaphragmatic pleura or peritoneum can produce referred pain via the phrenic and supraclavicular nerves

Question 36

dermatome - lateral margin of the upper lim

Answer 36

C3-6

Question 37

dermatome - middle finger

Answer 37

C7 dermatome

Question 38

dermatome - medial margin of the limb

Answer 38

C8, T1, and T2

Question 39

skin over the point of the shoulder and halfway down the lateral surface of the deltoid muscle

Answer 39

supraclavicular nerves (C3 and 4)

Question 40

C3 and 4 | Pain may be referred to this region as a result of inflammatory lesions involving the

Answer 40

diaphragmatic pleura or peritoneum

Question 41

s vicular nerves (C3 and 4). Pain may be referred to this region as a result of inflammatory lesions involving the diaphragmatic pleura or peritoneum. The afferent stimuli reach the spinal cord via the

Answer 41

phrenic nerves (C3, 4, and 5)

Question 42

The superficial veins are clinically important and are used for

Answer 42

venipuncture, transfusion, and cardiac catheterization.

Question 43

in this condition, the superficial veins are not always visible

Answer 43

state of shock

Question 44

The cephalic vein lies fairly constantly in the superficial fascia, immediately posterior to the

Answer 44

styloid process of the radius

Question 45

cubital fossa | vein present

Answer 45

median cubital vein

Question 46

In the cubital fossa, the median cubital vein is separated from the underlying brachial artery by the

Answer 46

bicipital aponeurosis

Question 47

This is important because it protects the artery from the mistaken introduction into its lumen of irritating drugs that should have been injected into the vein

Answer 47

bicipital aponeurosis - separates median cubital vein from the underlying brachial artery

Question 48

vein in the deltopectoral triangle

Answer 48

cephalic vein

Question 49

The cephalic vein, in the deltopectoral triangle, frequently communicates with the external jugular vein by

Answer 49

a small vein that crosses in front of the clavicle

Question 50

can result in rupture of this communicating vein (between cephalic vein and external jugular vein)

Answer 50

Fracture of the clavicle

Question 51

Fracture of the clavicle can result in rupture of this communicating vein,

Answer 51

with the formation of a large hematoma

Question 52

In extreme hypovolemic shock, this may inhibit venous blood flow and thus delay the introduction of intravenous blood into the vascular system.

Answer 52

excessive venous tone

Question 53

are the veins of choice for central venous catheterization

Answer 53

median basilic or basilic veins

Question 54

why is median basilic or basilic veins are the veins of choice for central venous catheterization

Answer 54

because from the cubital fossa until the basilic vein reaches the axillary vein, the basilic vein increases in diameter and is in direct line with the axillary vein

Question 55

The valves in the axillary vein may be troublesome for central venous catherization

Answer 55

abduction of the shoulder joint may permit the catheter to move past the obstruction

Question 56

why is cephalic vein not a good choice for central venous catherization

Answer 56

does not increase in size as it ascends the arm divides into small branches as it lies within the d topectoral triangle usually cephalic vein joins the axillary vein at a right angle (difficult to maneuver the catheter around this angle)

Question 57

Infection of the lymph vessels

Answer 57

lymphangitis

Question 58

Infection of the lymph vessels (lymphangitis) of the arm frequency

Answer 58

common

Question 59

Lymphangitis characteristic of the condition

Answer 59

Red streaks along the course of the lymph vessels

Question 60

The lymph vessels from the thumb and index finger and the lateral part of the hand follow this vein

Answer 60

cephalic vein

Question 61

The lymph vessels from the thumb and index finger and the lateral part of the hand follow the cephalic vein to the

Answer 61

infraclavicular group of axillary nodes

Question 62

those from the middle, ring, and little fingers and from the medial part of the hand follow this vein

Answer 62

basilic vein

Question 63

those from the middle, ring, and little fingers and from the medial part of the hand follow the basilic vein to the

Answer 63

supratrochlear node

Question 64

supratrochlear node | location

Answer 64

lies in the superficial fascia just above the medial epicondyle of the humerus

Question 65

the supratrochlear node follows to the

Answer 65

lateral group of axillary nodes

Question 66

Once the infection reaches the lymph nodes, they become enlarged and tender, a condition known as

Answer 66

lymphadenitis

Question 67

lymph vessels from fingers and palm direction of flow

Answer 67

fingers and palm dorsum of the hand forearm

Question 68

what is the complication that can happen after infection of the fingers or palm.

Answer 68

inflammatory edema, or even abscess formation, which may occur on the dorsum of the hand (because of the pathyway of the lymph vessels from fingers and palm

Question 69

The tendon of the long head of biceps is attached to this structure within the shoulder joint

Answer 69

supraglenoid tubercle

Question 70

Advanced osteoarthritic changes in the shoulder joint can lead to erosion and fraying of the tendon (long head of triceps) by

Answer 70

osteophytic outgrowths, and rupture of the tendon can occur.

Question 71

Fractures of the head of the radius can occur from falls on the

Answer 71

outstretched hand

Question 72

As the force is transmitted along the radius, the head of the radius is driven sharply against the

Answer 72

capitulum which leads to splitting or splintering the head

Question 73

Fractures of the neck of the radius occur in this population

Answer 73

young children

Question 74

Fractures of the neck of the radius occur in young children from falls on the

Answer 74

outstretched hand

Question 75

proximal fragment of the radius is supinated by the

Answer 75

supinator and the biceps brachii muscles

Question 76

The distal fragment of the radius is pronated and pulled medially by the

Answer 76

pronator quadratus muscle

Question 77

how are the fragments of the radius pulled

Answer 77

proximal - supinated | distal - pronated and pulled medially

Question 78

The strength of these muscles shorten and angulate the forearm

Answer 78

brachioradialis and extensor carpi radialis longus and brevis

Question 79

In fractures of the ulna, the ulna angulates

Answer 79

posteriorly

Question 80

To restore the normal movements of pronation and supination of the radius and ulna, this must be done

Answer 80

normal anatomic relationship of the radius, ulna, and interosseous membrane must be regained

Question 81

fracture of one forearm bone may be associated with

Answer 81

dislocation of the other bone (but not all the time)

Question 82

shaft of the ulna is fractured by a force applied from behind.

Answer 82

Monteggia’s fracture

Question 83

the position of bones in Monteggia’s fracture

Answer 83

bowing forward of the ulnar shaft and an anterior d location of the radial head with rupture of the anular ligament

Question 84

the proximal third of the radius is fractured and the distal end of the ulna is dislocated at the distal radioulnar joint.

Answer 84

Galeazzi’s fracture

Question 85

Fractures of the olecranon process can result from a fall on

Answer 85

flexed elbow or from a direct blow.

Question 86

this muscle is inserted on the olecranon process

Answer 86

triceps muscle

Question 87

Depending on the location of the fracture line of the olecranon process, the bony fragment may be displaced by the pull of this muscle

Answer 87

triceps muscle

Question 88

Avulsion fractures of part of the olecranon process can be produced by the pull of the

Answer 88

triceps muscle

Question 89

Good functional return after an olecranon fracture depends on the

Answer 89

accurate anatomic reduction of the fragment

Question 90

fracture of the distal end of the radius resulting from a fall on the outstretched hand

Answer 90

Colles’ fracture

Question 91

fracture of the distal end of the radius and occurs from a fall on the back of the hand

Answer 91

smith’s fracture

Question 92

Colles’ fracture | population usually affected

Answer 92

occurs in patients older than 50 years

Question 93

Colles’ fracture | position of fragments

Answer 93

force drives the d tal fragment posteriorly and superiorly, and the distal articular surface is inclined posteriorly

Question 94

This posterior displacement (Colles’ fracture)produces a posterior bump, sometimes referred to as the

Answer 94

dinner-fork deformity

Question 95

why is it called dinner-fork deformity

Answer 95

because the forearm and wrist resemble the shape of that eating utensil

Question 96

Failure to restore the distal articular surface (Colles’ fracture) to its normal position will severely limit the range of _____ of the wrist joint.

Answer 96

flexion

Question 97

It is a reversed Colles’ fracture because the distal fragment is displaced anteriorly

Answer 97

Smith’s fracture

Question 98

is present over the olecranon process of the ulna, and repeated trauma often produces

Answer 98

A small subcutaneous bursa

Question 99

A small subcutaneous bursa is present over the olecranon process of the ulna, and repeated trauma often produces

Answer 99

chronic bursitis

Question 100

Fracture of the scaphoid bone is common in what population

Answer 100

young adults

Question 101

Fracture of the scaphoid bone is common in young adults; unless treated effectively, the fragments will result to

Answer 101

not unite; permanent weakness and pain of the wrist, | subsequent development of osteoarthritis

Question 102

Scaphoid bone | The fracture line usually goes through the

Answer 102

narrowest part of the scaphoid (bathed in synovial fluid)

Question 103

blood supply of the scaphoid pathway

Answer 103

blood vessels to the scaphoid enter its proximal and distal ends, although the blood supply is occasionally confined to its distal end

Question 104

if blood supply is confined to the distal end of the scaphoid bone and a fracture occurs

Answer 104

avascular necrosis risk fracture deprives the proximal fragment of its a rial supply, and this fragment undergoes avascular necrosis

Question 105

Deep tenderness in the anatomic snuffbox after a fall on the outstretched hand in a young adult makes one suspicious of a

Answer 105

fractured scaphoid

Question 106

occasionally occurs in young adults who fall on the outstretched hand in a way that causes hyperextension of the wrist joint.

Answer 106

Dislocation of the lunate bone

Question 107

Dislocation of the lunate bone | what nerve is commonly involved

Answer 107

median nerve

Question 108

can occur as a result of direct violence, such as the clenched fist striking a hard object

Answer 108

Fractures of the metacarpal bones

Question 109

Fractures of the metacarpal bones | angulates

Answer 109

always angulates dorsally

Question 110

commonly produces an oblique fracture of the neck of the fifth and sometimes the fourth metacarpal bones.

Answer 110

boxer’s fracture

Question 111

position of the displacement in the fractures of the metacarpal bones (boxer’s fracture)

Answer 111

The distal fragment is commonly displaced proximally, thus shortening the finger posteriorly

Question 112

is a fracture of the base of the metacarpal of the thumb caused when violence is applied along the long axis of the thumb or the thumb is forcefully abducted.

Answer 112

Bennett’s fracture

Question 113

Bennett’s fracture | position of the fracture

Answer 113

The fracture is oblique and enters the carpometacarpal joint of the thumb, causing joint instability.

Question 114

The forearm is enclosed in a sheath of deep fascia, which is attached to the periosteum of the posterior subcutaneous border of the

Answer 114

ulna

Question 115

what divides the forearm into several compartments, each having its own muscles, nerves, and blood supply

Answer 115

fascial sheath, together with the interosseous membrane and fibrous intermuscular septa

Question 116

why is it very easy for compression of BV to occur in the forearm

Answer 116

There is very little room within each compartment, and any edema can cause secondary vascular compression of the blood vessels

Question 117

in secondary vascular compression of the blood vessels which vessels are first affected

Answer 117

veins then arteries

Question 118

this is a common cause of secondary vascular compression of the blood vessels in the forearm

Answer 118

soft tissue injury

Question 119

early signs of secondary vascular compression of the blood vessels

Answer 119

altered skin sensation (caused by ischemia of the sensory nerves passing through the compartment), pain disproportionate to any injury (caused by pressure on nerves within the compartment), pain on passive stretching of muscles that pass through the compartment (caused by muscle ischemia), tenderness of the skin over the compartment (a late sign caused by edema), and absence of capillary refill in the nail beds (caused by pressure on the arteries within the compartment)

Question 120

when diagnosis of compartment syndrome of the forearm is made tx

Answer 120

deep fascia must be incised surgically to decompress the affected compartment

Question 121

a delay in tx of compartment syndrome of how many hours will cause irreversible damage to the muscles

Answer 121

4 hours

Question 122

is a contracture of the m cles of the forearm that commonly follows fractures of the distal end of the humerus or fractures of the radius and ulna.

Answer 122

Volkmann’s ischemic contracture