Clinical Relevance Flashcards
How can a winged scapula occur?
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
What is a winged scapula?
Occurs when there is damage to the long thoracic nerve, paralysing the serratus anterior
Scapula is no longer held against the rib cage
What is compartment syndrome?
If an artery bleeds in a compartment, it can damage the nerve. Symptoms include pain and parasthesia
What produces the Popeye sign?
Rupture of the biceps tendon, most commonly the long head
Test the dorsal scapula nerve?
Test function of rhomboids
Patient places hands on hips, pushes elbows posteriorly against resistance
Test the axillary nerve?
Abduct arm above 15* against resistance - deltoid can be seen and palpated
Test for accessory nerve?
Ask patient to shrug shoulders against resistance. Tests the trapezius also
If you have a fracture of the surgical neck of the humerus, what structures should you be concerned about?
Axillary nerve and posterior circumflex artery
How would you test damage to the axillary nerve?
Patient cannot abduct their arm due to loss of function of deltoid and teres minor
Regimental badge area
What structures are we concerned about in a mid shaft fracture of the humerus?
Radial nerve and profunda brachii artery which are tightly bound in the radial groove
What do we see if there is damage to the radial nerve?
Wrist drop - it innervates the extensors of the forearm so will be paralysed and there is unopposed flexion of the wrist.
How can you get a distal humeral fracture?
Falling on a flexed elbow
What can be seen in a distal humeral fracture?
Volkmann’s ischaemic contracture - uncontrolled flexion of the hand due to flexors becoming fibrotic and short
What structures are we concerned about in a distal humeral fracture?
Medial, ulnar and radial nerves.
Brachial artery
What do you see as a result of damage to the ulnar nerve?
Ulnar claw
What is the ulnar claw?
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
Someone has come in with a dinner fork deformity. What has happened?
Received a Colles fracture. They have posteriorly displaced the distal fragment of the radius.
What happens if you break your scaphoid?
Tenderness over anatomical snuffbox.
Can lead to avascular necrosis
How might you anteriorly dislocate your shoulder?
Trauma to a fully abducted arm, usually from a posterior direction
What can be injured if you anteriorly dislocate your shoulder?
Axillary nerve
Radial nerve
How can an upper brachial plexus injury occur?
A difficult birth or blow to the shoulder
Which nerves are affected in an upper brachial plexus injury?
Those derived from C5 and C6
Musculocutaneous, axillary, suprascapular and nerve to subclavius
Which muscles are paralysed in an upper brachial plexus injury?
Supraspinatus, infraspinatus, subclavius, biceps brachii, brachialis, coracobrachialis, deltoid and teres minor
What movements are lost or greatly weakened in an upper brachial plexus injury? What sensory things are lost?
Abduction of the shoulder, lateral rotation of the arm, supination of forearm and flexion at the shoulder
Lateral side of arm
Characteristic sign of an upper brachial plexus injury?
Limb hangs limply, medially rotated, forearm pronates
Known as waiter’s tip
What can cause a lower brachial plexus injury?
Excessive abduction of the arm
Which nerves are affected in a lower brachial plexus injury?
Ulnar and median nerves
Because they are derived from T1
What is affected in a lower brachial plexus injury?
Small muscles of the hand
Loss of sensation along medial side of arm
Characteristic signs of a lower brachial plexus injury?
Clawed hand, hyperextension at metacarpophalangeal joints, flexion at interphalangeal joints
Where does an intracapsular fracture occur?
In the neck of the femur within the joint capsule
Who is an intracapsular fracture common in?
The elderly after a stumble
What structures are at risk in an intracapsular fracture?
Femoral circumflex artery
Avascular necrosis of the femoral head
What does someone who has an intracapsular fracture look like? Why?
Distal fragment is pulled upwards and laterally rotated to give a shorter leg length and lateral pointing toes.
Who is an extracapsular fracture more common in?
Young people
What is an aneurysm?
Dilation of an artery, greater than 50% of the normal diameter.
Where can the femoral pulse be palpated?
As it enters the femoral triangle, midway between the ASIS and the pubic symphysis.
How can the popliteal artery be palpated?
Lie patient on their front and ask them to slightly flex their knee. Deep in the popliteal fossa.
Where can the dorsalis pedis pulse be palpated?
Dorsum of the foot, just lateral to extensor hallucis longus tendon.
What is a strain?
Excessive stretch/tearing of muscle fibres
What is an avulsion fracture?
When a fragment of bone breaks away from the main body of the bone
6Ps of compartment syndrome?
Pain Pulseless Pallor Paralysis Perishingly cold Paraesthesia
What is compartment syndrome?
Increased pressure within a compartment.
Increased impairment of muscle and nerve function and necrosis of soft tissue.
Reduced blood flow
Causes of compartment syndrome?
Fractures Burns Infection Burns Prolonged limb compression
Which nerve is damaged if someone has foot drop?
Common fibular nerve/deep fibular nerve
Patient cannot plantarflexes the foot against resistance and foot is permanently dorsi flexed. Likely diagnosis?
Ruptured calcaneal tendon
What is intermittent claudication?
Pain on walking and relived by rest.
Due to a build of atherosclerotic plaque
Limits flow to muscles causing ischaemia and pain
What is piriformis syndrome?
Pain in the buttock resulting from compression of the sciatic nerve by the piriformis muscle.
Which artery can be damaged in a neck of femur fracture?
Medial femoral circumflex
