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MSK > Clinical Relevance > Flashcards

Clinical Relevance Flashcards

0
Q

How can a winged scapula occur?

A

Trauma to the shoulder
Repetitive movements involving the shoulder
Removal axillary lymph nodes - surgery can damage the nerve
Structures becoming inflamed and pressing on the nerve

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1
Q

What is a winged scapula?

A

Occurs when there is damage to the long thoracic nerve, paralysing the serratus anterior
Scapula is no longer held against the rib cage

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2
Q

What is compartment syndrome?

A

If an artery bleeds in a compartment, it can damage the nerve. Symptoms include pain and parasthesia

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3
Q

What produces the Popeye sign?

A

Rupture of the biceps tendon, most commonly the long head

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4
Q

Test the dorsal scapula nerve?

A

Test function of rhomboids

Patient places hands on hips, pushes elbows posteriorly against resistance

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5
Q

Test the axillary nerve?

A

Abduct arm above 15* against resistance - deltoid can be seen and palpated

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6
Q

Test for accessory nerve?

A

Ask patient to shrug shoulders against resistance. Tests the trapezius also

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7
Q

If you have a fracture of the surgical neck of the humerus, what structures should you be concerned about?

A

Axillary nerve and posterior circumflex artery

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8
Q

How would you test damage to the axillary nerve?

A

Patient cannot abduct their arm due to loss of function of deltoid and teres minor
Regimental badge area

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9
Q

What structures are we concerned about in a mid shaft fracture of the humerus?

A

Radial nerve and profunda brachii artery which are tightly bound in the radial groove

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10
Q

What do we see if there is damage to the radial nerve?

A

Wrist drop - it innervates the extensors of the forearm so will be paralysed and there is unopposed flexion of the wrist.

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11
Q

How can you get a distal humeral fracture?

A

Falling on a flexed elbow

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12
Q

What can be seen in a distal humeral fracture?

A

Volkmann’s ischaemic contracture - uncontrolled flexion of the hand due to flexors becoming fibrotic and short

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13
Q

What structures are we concerned about in a distal humeral fracture?

A

Medial, ulnar and radial nerves.

Brachial artery

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14
Q

What do you see as a result of damage to the ulnar nerve?

A

Ulnar claw

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15
Q

What is the ulnar claw?

A

Little and ring fingers are hyperextended at the MCP and flexed at both the IP joints.
This is because the ulna nerve innervates the medial two lumbricals which normally flexes at the MCP joint and extends at the IP joint

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16
Q

Someone has come in with a dinner fork deformity. What has happened?

A

Received a Colles fracture. They have posteriorly displaced the distal fragment of the radius.

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17
Q

What happens if you break your scaphoid?

A

Tenderness over anatomical snuffbox.

Can lead to avascular necrosis

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18
Q

How might you anteriorly dislocate your shoulder?

A

Trauma to a fully abducted arm, usually from a posterior direction

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19
Q

What can be injured if you anteriorly dislocate your shoulder?

A

Axillary nerve

Radial nerve

20
Q

How can an upper brachial plexus injury occur?

A

A difficult birth or blow to the shoulder

21
Q

Which nerves are affected in an upper brachial plexus injury?

A

Those derived from C5 and C6

Musculocutaneous, axillary, suprascapular and nerve to subclavius

22
Q

Which muscles are paralysed in an upper brachial plexus injury?

A

Supraspinatus, infraspinatus, subclavius, biceps brachii, brachialis, coracobrachialis, deltoid and teres minor

23
Q

What movements are lost or greatly weakened in an upper brachial plexus injury? What sensory things are lost?

A

Abduction of the shoulder, lateral rotation of the arm, supination of forearm and flexion at the shoulder

Lateral side of arm

24
Q

Characteristic sign of an upper brachial plexus injury?

A

Limb hangs limply, medially rotated, forearm pronates

Known as waiter’s tip

25
Q

What can cause a lower brachial plexus injury?

A

Excessive abduction of the arm

26
Q

Which nerves are affected in a lower brachial plexus injury?

A

Ulnar and median nerves

Because they are derived from T1

27
Q

What is affected in a lower brachial plexus injury?

A

Small muscles of the hand

Loss of sensation along medial side of arm

28
Q

Characteristic signs of a lower brachial plexus injury?

A

Clawed hand, hyperextension at metacarpophalangeal joints, flexion at interphalangeal joints

29
Q

Where does an intracapsular fracture occur?

A

In the neck of the femur within the joint capsule

30
Q

Who is an intracapsular fracture common in?

A

The elderly after a stumble

31
Q

What structures are at risk in an intracapsular fracture?

A

Femoral circumflex artery

Avascular necrosis of the femoral head

32
Q

What does someone who has an intracapsular fracture look like? Why?

A

Distal fragment is pulled upwards and laterally rotated to give a shorter leg length and lateral pointing toes.

33
Q

Who is an extracapsular fracture more common in?

A

Young people

34
Q

What is an aneurysm?

A

Dilation of an artery, greater than 50% of the normal diameter.

36
Q

Where can the femoral pulse be palpated?

A

As it enters the femoral triangle, midway between the ASIS and the pubic symphysis.

37
Q

How can the popliteal artery be palpated?

A

Lie patient on their front and ask them to slightly flex their knee. Deep in the popliteal fossa.

38
Q

Where can the dorsalis pedis pulse be palpated?

A

Dorsum of the foot, just lateral to extensor hallucis longus tendon.

39
Q

What is a strain?

A

Excessive stretch/tearing of muscle fibres

40
Q

What is an avulsion fracture?

A

When a fragment of bone breaks away from the main body of the bone

41
Q

6Ps of compartment syndrome?

A 
Pain
Pulseless
Pallor
Paralysis
Perishingly cold
Paraesthesia
42
Q

What is compartment syndrome?

A

Increased pressure within a compartment.
Increased impairment of muscle and nerve function and necrosis of soft tissue.
Reduced blood flow

43
Q

Causes of compartment syndrome?

A 
Fractures
Burns
Infection
Burns
Prolonged limb compression
44
Q

Which nerve is damaged if someone has foot drop?

A

Common fibular nerve/deep fibular nerve

45
Q

Patient cannot plantarflexes the foot against resistance and foot is permanently dorsi flexed. Likely diagnosis?

A

Ruptured calcaneal tendon

46
Q

What is intermittent claudication?

A

Pain on walking and relived by rest.
Due to a build of atherosclerotic plaque
Limits flow to muscles causing ischaemia and pain

47
Q

What is piriformis syndrome?

A

Pain in the buttock resulting from compression of the sciatic nerve by the piriformis muscle.

48
Q

Which artery can be damaged in a neck of femur fracture?

A

Medial femoral circumflex

MSK (29 decks)

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