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Anatomy > Clinical Topics > Flashcards

Clinical Topics Flashcards

1
Q

DVT

Deep Venous Thrombosis

A

Use of general anesthesia (muscle relaxant drugs) or prolonged sitting

  • slows down the blood flow in the deep veins
  • result in pooling of the blood
    • leads to a high risk of clot formation
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2
Q

Potential Collateral Circulation

A

alternate channels that ensure the blood supply to structures distal to the blockage

  • require time to open adequately
    • insufficient to compensate for a sudden or acute incident

Gradual occlusion of the main vessel = activation of the collateral circulation

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3
Q

Compartment Syndrome

A

excessive pressure builds up inside an enclosed space in the body

bleeding from a fractured bone or swelling after a crush injury

  • tough walls of fascia cannot easily expand
  • pressure rises inside compartemnt

Tx fasciotomy

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4
Q

Impingement Syndrome of Supraspinatus

A

if supraspinatus tendon is thickened by an inflammatory or degenerative process,

  • difficulty sliding in the canal

f there’s nodular swelling

  • can get stuck in the canal
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5
Q

Rotator Cuff Syndrome (Tendonitis/Impingement)

A

very common shoulder injury

  • from repetitive use or direct trauma
    • head of humerus compresses against coraco-acromial arch
    • rupture of supraspinatus tendon
      • loss of abduction 0-15
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6
Q

Calcific Supraspinatus Tendinitis & Subacromial bursitis

subacromial painful arc syndrome

A

Subacromial bursitis

  • calcium deposition into the supraspinatus tendon
  • irritates the overlying subacromial bursa

excruciating pain during abduction of the arm

adducted the patient is pain-free

abduct the shoulder

  • pain occur during 60-120° of abduction
  • supraspinatus tendon is in direct contact with the acromion and coraco-acromial arch
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7
Q

Axillar nerve injury

A

usually injured by

  • fracture of surgical neck of humerus
  • dislocation of glenohumeral joint
  • compression from incorrect use of crutches

Result

  • Inability to abduct the arm (15-90 degrees)
  • Loss of sensation over lateral aspect of proximal of arm
  • deltoid atrophy
    • ​​flattened shoulder look
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8
Q

Suprascapular Nerve Palsy

relatively uncommon

A

nerve entrapment or injury caused by

  • repetitive overhead motion
  • Compressive by cyst

occurs in

  • Suprascapular notch (both infra/supraspinatus)
  • spinoglenoid notch (infraspinatus effected)

results

  • weakness or Atrophy
  • loss of initiation of abduction (supraspinatus)
  • loss of lateral rotation (infraspinatus)
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9
Q

Winged scapula

A

Paralysis of serratus anterior

  • a result of damage to long thoracic nerve

Results

  • unable to do any pushing action
  • limited to no abduction
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10
Q

Breast Cancer

A

Cancer in Cooper’s Ligament

  • large dimples

Cancer in subareolar region

  • retracted nipple

Cancer of Dermal Lymphatics

  • orange peel texture
  • little pore at copper ligament attachment sites

Screen using Mammogram

  • looking for regions of ill-defined dense (high in fatty elements) masses
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11
Q

Metastases of Breast Cancer

A

Breast cancer spreads via the lymphatics of the breast

Sentinel Node

  • first lymph node to receive lymph drainage from breast
  • tested through injection of a dye

Post-Mastectomy

  • lymphedema in the upper extremities
  • swelling with no pitting
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12
Q

Gynecomastia

A

breast hypertrophy in males after puberty

  • triggered by a decrease in amount of testosterone present compared to estrogen
  • achieved through
    • Reduced androgen production (hypogonadism)
    • Androgen resistance (testicular feminization)
    • Increased estrogen secretion
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13
Q

Dislocation of the SC joint

very rare

A

Caused by

  • a fall on the shoulder or outstretched hand

Anterior dislocation is more common than posterior

  • posterior dislocation is life-threatening
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14
Q

Dislocation of the AC joint

A

Caused by

  • hard fall on the shoulder
  • severe blow to the back

Result

  • AC and the coracoclavicular ligaments are torn
  • shoulder separation (acromion sits below clavicle)
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15
Q

Dislocation of the glenohumeral Joint

A

Caused by

  • abduction (90°) and excessive extension and lateral rotation
    • head of the humerus is driven antero-inferiorly
    • fibrous capsule and glenoid labrum stripped
  • hard blow to the humerus when fully abducted
    • tilts the head of the humerus inferiorly onto the inferior weak part of capsule

Results

  • Injury to the axillary nerve
  • stretching of radial nerve and posterior cord of brachial plexus
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16
Q

Adhesive Capsulitis

(frozen shoulder)

A

Fibrosis and inflammation of the joint capsule, bursae, rotator cuff muscles and/or deltoid

Cause

  • spontaneous onset
  • common in middle-aged DM pts
  • may be due to prolonged immobilization

Results

  • progressive pain and stiffness
  • No tenderness
  • ROM are limited
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17
Q

inferior vena cava blockage

A

lateral thoracic vein + superficial epigastric vein join to form the thoraco-epigastricvein which providescollateralroute during blockage

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18
Q

Brachial plexus block

A

Injection of anesthetic solution into the axillary sheath

  • interrupts conduction
  • produce anesthesia
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19
Q

Erb-Duchenne palsy

A

Caused by

  • excessive increase in the angle between the neck and the shoulder
    • Birth injury
    • Fall on the shoulder

Results in

  • avulsion of the C5, C6 roots
  • loss of sensation of lateral aspect of arm
  • arm adducted and medially rotated
  • forearm extended and pronated
    • waiter tip hand
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20
Q

Klumpke’s paralysis

A

Caused by

  • the undue abduction of arm
  • grasp something to break a fall
  • Birth injury: baby’s upper limb is pulled excessively during delivery

Results

  • avulsion of roots T1 and C8
  • Claw hand + ape thumb
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21
Q

Thoracic outlet syndrome

A

Caused by

  • compression of subclavian vessels and brachial plexus
  • vascular compression less common than neurologic compression

Pain

  • neurologic: paresthesia of the neck, shoulder, arm, and hand
  • vascular: coldness, weakness, fatigability of the hand and arm
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22
Q

Biceps tendinitis

A

Caused by:

  • Inflammation of the tendon result from repetitive micro-trauma

Result

  • tenderness in the bicipital groove
  • Resisted elbow flexion
  • resisted shoulder flexion
  • resisted supination with elbow flexed
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23
Q

Rupture of the tendon of long head of biceps brachii

A

Caused by

  • Biceps tendinitis
  • tendon is torn from its attachment to the supraglenoid tubercle

Result

  • Popeye sign
    • biceps muscle belly forms a ball near center of the arm
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24
Q

Distal biceps tendon rupture

A

Caused by

  • Injuries to the distal biceps tendon
  • Unanticipated loading of the tendon (catching something thats falling)

Result

  • avulses from its radial tuberosity insertion
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25
Q

Median nerve injury/paralysis

A

Apelike thumb & hand of benediction deformity

26
Q

Ulnar nerve injury

A

Caused by

  • Fracture of the medial epicondyle of the humerus
  • Cubital tunnel syndrome (entrapment syndrome)

Paralysis of

  • Flexor carpi ulnaris,
  • medial half of flexor digitorum profundus

ulnar claw hand deformity

27
Q

Radial nerve injury

A

Caused by

  • Contusion of the arm
  • Fracture of the shaft of the humerus

Results

  • Loss of extension of the wrist & MCP joints
  • Wrist drop deformity
  • Triceps brachii spared extension of elbow is possible
28
Q

Volkmann’s Ischemic Contracture

A

Caused by

  • contractures of muscles of forearm
    • due to fractures of distal end of humerus or fractures of radius and ulna
  • reduces the blood flow to the flexors and extensor muscles

Result

  • ischemic necrosis
    • muscles are replaced by fibrous tissue
29
Q

TRAUMATIC INJURY TO BRACHIAL ARTERY

A

Caused by

  • penetrating or blunt trauma
  • arterial tap perforation

Results in

  • ischemia and severe disability if anastomoses around elbow are inadequate
30
Q

Pronator Syndrome (median nerve entrapment)

A

Caused by

  • compressed of median nerve as it passes between two heads of pronator teres
  • pain upon pronation
31
Q

Dupuytren’s contracture

A

Caused by

  • Gradual thickening and fibrosis of palmar aponeurosis

Results

  • progressive shortening of the palmar fascia
    • affects 4th + 5th digits

Tx

  • surgical removal of palmar aponeurosis
32
Q

Allen Test

A

test the patency of the radial and ulnar arteries

  1. occluding both radial and ulnar arteries at the wrist by direct pressure
  2. asked pt to open their hand (should be white)
  3. release pressure over one of two artery
    • hand should turn pink (blood flow return)
  4. repeat test with other artery

If the palm does not become pink this signifies an occlusion of the released artery

33
Q

Ulnar Canal Syndrome (Handlebar neuropathy)

A

Caused by

  • compression of the ulnar nerve at wrist in Guyon Canal

Results

  • Weakness and clawing of the 4th and 5th digits
34
Q

Carpal Tunnel Syndrome

A

Caused by

  • Any lesion that reduces the size of the tunnel
  • increases the size of some the tendons

Results

  • Compression of the median nerve
  • Paresthesia (tingling), hypoesthesia, and anesthesia
35
Q

stenosing tenosynovitis

(Trigger Finger)

A

Caused by

  • inflammation and fibrosis of the flexor tendon sheath
  • inflammation narrows the space within the sheath
  • nodule may be present

results

  • One of the fingers gets stuck in a bent position
  • finger may straighten with a snap
36
Q

Lateral epicondylitis

(tennis elbow)

A

most commonly involved is extensor carpi radialis brevis

Caused by

  • weakened from overuse, microscopic tears
  • inflammation
  • repeated, forceful contraction of the wrist extensor, with repeated pronation + supination

Results

  • severe inflammation and pain
37
Q

Posterior interosseous nerve entrapment syndrome

A

Caused by

  • Radial nerve entrapment in radial tunnel btw brachialis and brachioradialis

Results

  • both motor and sensory deficits
  • pain
  • weakness of finger
  • decreased wrist extension

Posterior interosseous nerve syndrome

caused by

  • entrapment nerve passes between the two heads of supinator
  • repetitively pronate and supinate of arm

Results

  • gradual onset of weakness of muscles
  • motor but no sensory deficits
38
Q

Ganglion or Synovial Cyst of Wrist

A

non-tender cystic swelling on dorsal wrist

contains clear mucinous fluid

Flexion causes cyst to enlarge and cause pain

39
Q

De Quervain’s tenosynovitis

(texting thumb)

A

Caused by

  • Inflammation of abductor pollicis longus, extensor pollicis brevis and synovial sheath

Results

  • server pain against resistance or adduction

Affects women more often than men

40
Q

Mallet or Baseball Finger

A

Caused by

  • Sudden severe tension on a long extensor tendon
  • distal interphalangeal joint suddenly being forced into extreme flexion

Results

  • avulse the attachment of the tendon to the base of distal phalanx
  • hanging finger tip
41
Q

Swan Neck or Boutonniere

A

deformities of the rheumatoid hand

42
Q

Cubital Valgus vs Varus

A

carrying angle of the arms

Cubital Valgus greater than 15 degrees

Cubital Varus less than 5 degrees

43
Q

Subcutaneous bursitis

A

Caused by

  • Falls on the elbow
  • infection of the skin covering the olecranon
  • repeated excessive pressure and friction

Results

  • inflammation
  • pain
44
Q

Subtendinous olecranon bursitis

A

Caused by

  • excessive friction between the triceps tendon and olecranon
  • repeated flexion–extension

Results

  • pain is most severe during flexion
    • pressure exerted on the bursa by the triceps tendon
45
Q

Posterior Dislocation of the elbow

A

Caused by

  • fall on hands when elbows flexed
  • distal end of the humerus is driven through the weak anterior part of the joint capsule

Result

  • radius and ulna dislocate posteriorly
  • ulnar collateral ligament torn
  • Injury to ulnar nerve
  • fracture of the head of the radius, coronoid process, or olecranon process
46
Q

traction apophysitis

Young Athlete’s Elbow Injury

A

Caused by

  • repetitive action such as throwing a ball

Results

  • medial elbow pain in young athletes

elbow area is the last epiphyseal center to close

47
Q

Medial Epicondylitis

(golfer’s elbow)

A

Caused by

  • overuse of wrist flexors + forearm pronator
  • micro-tearing of flexor carpi radialis and pronator teres

Results

  • medial elbow pain
48
Q

Subluxation of the radial head

(Nursemaid’s Elbow/ Pulled elbow)

A

common and painful injury of small children

Caused by

  • arm is jerked upward with the forearm pronated
  • radial head slips out of the annular ligament

Results

  • the ligament may become trapped between the radial head and the capitulum

Tx

  • Supinating the forearm and flexing the elbow
49
Q

Colles fracture

A

most common fracture of the forearm in people 50+

Caused by

  • complete transverse fracture of the distal radius
  • trying to break a fall by outstretching the upper limb

Results

  • dinner fork deformity
50
Q

Fracture of the scaphoid

A

common in young adult

prolonged healing time due to the poor blood supply to the proximal part of the scaphoid

Avascular necrosis may occur

51
Q

Anterior dislocation of the lunate

A

uncommon but severe

Caused by

  • fall on the extended wrist

Results

  • displaced lunate may compress the median nerve
  • lead to carpal tunnel syndrome
  • poor blood supply may lead to avascular necrosis
52
Q

Epiphyseal injury

A

common in children

Caused by

  • fall on hand with transmitted force to the radius

Results

  • fracture + separation of distal radial epiphysis
53
Q

Hamate fracture

A

Caused by

  • the handle of a golf club, tennis racquet or baseball bat

Results

  • wrist pain, weakness
  • Injury to deep branch of ulnar nerve
54
Q

Peripheral neuropathy

Nerve transections vs Compression

A

Nerve transections = Acute loss of function

Compression neuropathy = Gradual loss of function

55
Q

Principles of localization of the Site of nerve injury

A
  1. What is the motor function?
    • Is it present?
  2. What is the Sensory Function?
    • Is it present?
56
Q

Suprascapular Nerve Compression

A

Ganglion Cyst

entrapped it passes through the suprascapular foramen to reach the supraspinous fossa

57
Q

Long thoracic nerve injury

A

winged scapula

loss of serratus anterior function

58
Q

Axillar nerve injury

A

Crutch Palsy

Fracture of the surgical neck of the humerus

Dislocation of the glenohumeral joint

Compression from the incorrect use of crutches

59
Q

Musculocutaneous nerve injury

A

as pierces coracobrachialis may become entrapment

60
Q

Ulnar nerve injury

A

Klmupke’s Claw Hand

Partial Claw Hand

Caused by

  • Fracture of the medial epicondyle of the humerus
  • Cubital tunnel syndrome (entrapment)
  • Ulnar (Guyon) canal syndrome (entrapment)
  • Handle-bar neuropathy (compression)
  • Fracture of the hook of hamate
61
Q

Median nerve injury

A

Caused by

  • Supracondylar fracture
  • Pronator Syndrome (entrapment)
  • Carpal tunnel syndrome (entrapment)
  • Stab or iatrogenic (surgical damage) wounds in the palm of recurrent branch of median nerve
62
Q

Radial nerve injury

A

Caused by

  • axilla by crutches (compression)
  • Contusion of the arm
  • Fracture of the mid-shaft of the humerus
  • Radial canal entrapment (between brachialis and brachioradialis)
  • passes between the two head of supinator muscle (deep branch or posterior interosseous)

Anatomy (7 decks)

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