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Anatomy Review Upper Limb > Clinical notes > Flashcards

Clinical notes Flashcards

1
Q

The strong costoclavicular ligament firmly holds the

A

medial end of the clavicle to the 1st costal cartilage

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2
Q

the reason why dislocation of the sternoclavicular joint takes place occasionally

A

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

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3
Q

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

A

Anterior dislocation

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4
Q

Anterior dislocation

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

A

sternocleidomastoid muscle.

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5
Q

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

A

Posterior dislocation

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6
Q

why is the posterior dislocation of the sternoclavicular joint more serious

A

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

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7
Q

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

A

costoclavicular ligament

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8
Q

The plane of the articular surfaces of the acromioclavicular joint passes_______

A

downward and medially

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9
Q

The strength of the acromioclavicular joint depends on the

A

strong coracoclavicular ligament

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10
Q

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

A

ride up over the upper surface of the acromion

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11
Q

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

A

strong coracoclavicular ligament

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12
Q

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

A

strong coracoclavicular ligament

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13
Q

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

A

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

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14
Q

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

A

shoulder separation

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15
Q

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

A

immediate redislocation

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16
Q

what factors contribute to the instability of the shoulder joint

A

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

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17
Q

strength of the shoulder joint depends on the

A

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

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18
Q

what forms the rotator cuff

A 
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
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19
Q

least supported part of the joint

A

inferior location, where it is unprotected by muscles.

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20
Q

is the most commonly dislocated large joint

A

shoulder joint

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21
Q

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

A

Anterior Inferior Dislocation

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22
Q

Anterior Inferior Dislocation

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

A

subcoracoid position

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23
Q

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

A

strong flexors and adductors of the shoulder joint

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24
Q

quadrangular space boundaries

A

superior - subscapularis, capsule of the shoulder joint

inferior - teres major m.

medial - long head of triceps

lateral - surgical neck of humerus

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25
Q

what are the contents of the quadrangular space

A

axillary nerve

posterior circumflex humeral vessels

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26
Q

Posterior dislocations are rare and are usually caused by

A

direct violence to the front of the joint

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27
Q

this landmark is important in identifying posterior shoulder dislocation

A

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

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28
Q

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

A

subglenoid displacement

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29
Q

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

A

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

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30
Q

this nerve can be damaged by downward displacement of humerus

A

radial nerve and axillary nerve

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31
Q

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

A

axillary nerve and the suprascapular nerve

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32
Q

the shoulder joint is

A

sensitive to pain, pressure, excessive traction, and distention

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33
Q

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

A

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

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34
Q

Injury to the shoulder joint is followed by

A

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

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35
Q

what other diseases can cause shoulder pain

A

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

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36
Q

dermatome - lateral margin of the upper lim

A

C3-6

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37
Q

dermatome - middle finger

A

C7 dermatome

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38
Q

dermatome - medial margin of the limb

A

C8, T1, and T2

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39
Q

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

A

supraclavicular nerves (C3 and 4)

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40
Q

C3 and 4

Pain may be referred to this region as a result of inflammatory lesions involving the

A

diaphragmatic pleura or peritoneum

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41
Q

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

A

phrenic nerves (C3, 4, and 5)

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42
Q

The superficial veins are clinically important and are used for

A

venipuncture, transfusion, and cardiac catheterization.

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43
Q

in this condition, the superficial veins are not always visible

A

state of shock

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44
Q

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

A

styloid process of the radius

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45
Q

cubital fossa

vein present

A

median cubital vein

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46
Q

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

A

bicipital aponeurosis

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47
Q

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

A

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

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48
Q

vein in the deltopectoral triangle

A

cephalic vein

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49
Q

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

A

a small vein that crosses in front of the clavicle

50
Q

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

A

Fracture of the clavicle

51
Q

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

A

with the formation of a large hematoma

52
Q

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

A

excessive venous tone

53
Q

are the veins of choice for central venous catheterization

A

median basilic or basilic veins

54
Q

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

A

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

55
Q

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

A

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

56
Q

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

A

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)

57
Q

Infection of the lymph vessels

A

lymphangitis

58
Q

Infection of the lymph vessels (lymphangitis) of the arm

frequency

A

common

59
Q

Lymphangitis

characteristic of the condition

A

Red streaks along the course of the lymph vessels

60
Q

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

A

cephalic vein

61
Q

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

A

infraclavicular group of axillary nodes

62
Q

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

A

basilic vein

63
Q

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

A

supratrochlear node

64
Q

supratrochlear node

location

A

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

65
Q

the supratrochlear node follows to the

A

lateral group of axillary nodes

66
Q

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

A

lymphadenitis

67
Q

lymph vessels from fingers and palm

direction of flow

A

fingers and palm
dorsum of the hand
forearm

68
Q

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

A

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

69
Q

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

A

supraglenoid tubercle

70
Q

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

A

osteophytic outgrowths, and rupture of the tendon can occur.

71
Q

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

A

outstretched hand

72
Q

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

A

capitulum
which leads to
splitting or splintering the head

73
Q

Fractures of the neck of the radius occur in this population

A

young children

74
Q

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

A

outstretched hand

75
Q

proximal fragment of the radius is supinated by the

A

supinator and the biceps brachii muscles

76
Q

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

A

pronator quadratus muscle

77
Q

how are the fragments of the radius pulled

A

proximal - supinated

distal - pronated and pulled medially

78
Q

The strength of these muscles shorten and angulate the forearm

A

brachioradialis and extensor carpi radialis longus and brevis

79
Q

In fractures of the ulna, the ulna angulates

A

posteriorly

80
Q

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

A

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

81
Q

fracture of one forearm bone may be associated with

A

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

82
Q

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

A

Monteggia’s fracture

83
Q

the position of bones in Monteggia’s fracture

A

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

84
Q

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

A

Galeazzi’s fracture

85
Q

Fractures of the olecranon process can result from a fall on

A

flexed elbow or from a direct blow.

86
Q

this muscle is inserted on the olecranon process

A

triceps muscle

87
Q

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

A

triceps muscle

88
Q

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

A

triceps muscle

89
Q

Good functional return after an olecranon fracture depends on the

A

accurate anatomic reduction of the fragment

90
Q

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

A

Colles’ fracture

91
Q

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

A

smith’s fracture

92
Q

Colles’ fracture

population usually affected

A

occurs in patients older than 50 years

93
Q

Colles’ fracture

position of fragments

A

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

94
Q

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

A

dinner-fork deformity

95
Q

why is it called dinner-fork deformity

A

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

96
Q

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

A

flexion

97
Q

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

A

Smith’s fracture

98
Q

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

A

A small subcutaneous bursa

99
Q

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

A

chronic bursitis

100
Q

Fracture of the scaphoid bone is common in what population

A

young adults

101
Q

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

A

not unite; permanent weakness and pain of the wrist,

subsequent development of osteoarthritis

102
Q

Scaphoid bone

The fracture line usually goes through the

A

narrowest part of the scaphoid (bathed in synovial fluid)

103
Q

blood supply
of the scaphoid
pathway

A

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

104
Q

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

A

avascular necrosis risk

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

105
Q

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

A

fractured scaphoid

106
Q

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

A

Dislocation of the lunate bone

107
Q

Dislocation of the lunate bone

what nerve is commonly involved

A

median nerve

108
Q

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

A

Fractures of the metacarpal bones

109
Q

Fractures of the metacarpal bones

angulates

A

always angulates dorsally

110
Q

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

A

boxer’s fracture

111
Q

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

A

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

112
Q

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.

A

Bennett’s fracture

113
Q

Bennett’s fracture

position of the fracture

A

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

114
Q

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

A

ulna

115
Q

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

A

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

116
Q

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

A

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

117
Q

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

A

veins then arteries

118
Q

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

A

soft tissue injury

119
Q

early signs of secondary vascular compression of the blood vessels

A

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)

120
Q

when diagnosis of compartment syndrome of the forearm is made
tx

A

deep fascia must be incised surgically to decompress the affected compartment

121
Q

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

A

4 hours

122
Q

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.

A

Volkmann’s ischemic contracture

Anatomy Review Upper Limb (3 decks)

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