Exam 2 Flashcards
Clavicle?
Medial 2/3 is convex anteriorly and lateral 1/3 is concave anteriorly
What is cleidocranial dysostosis?
Bones of skull & defects on ossification. Bone might be missing as well
Fractures of the surgical neck?
Injury to the axillary nerve.
Abduction of the arm with innervation of deltoid.
Fractures of the middle of the shaft?
May cause injury to the radial nerve
WRIST DROP
Fractures of the distal end of humerus?
Injury to the median nerve
Fractures to the medial epicondyle?
Injury to the ulnar nerve.
FUNNY BONE
When does traumatic separation of the proximal epiphysis usually occur?
18-20 years. Also in younger children since the capsule is stronger.
All muscles of the back of the arm are innervated by?
Radial n.
Damage to ulnar nerve leads to?
Claw hand
Colle’s fracture?
Fracture of the distal end of the radius, posterior displacement. Falling on hand with extended arm (eg. falling on ice). May be accompanied by avulsion of ulnar styloid process.
Carpal bones?
2 rows. Each row 4 bones. Sesamoid bones
Order of carpal bones
1) Some Lovers Try Positions
2) That They Can’t Handle
Which bones does the proximal row of the carpal bones contain?
Scaphoid (largest in this row), lunate, triquetrum, pisiform
Which bones does the distal row of the carpal bones contain?
Trapezium, trapezoid, capitate (biggest in 2nd row), hamate, hamulus (hook of hamate)
Which is the most fractured bone among the carpal bones?
Scaphoid bone
Which is the 2nd most fractured bone among the carpal bones?
Triquetrum
Which is the most dislocated carpal bone?
Lunate bone
What is the carpal tunnel?
The 2 rows of the carpal bones produce the carpal groove which is concave anteriorly
What is the flexor retinaculum?
Is a double layer of membrane covering the carpal groove anteriorly and produces the carpal tunnel for transmission of flexor muscles and median nerve
What are the points of insertion of flexor retinaculum?
Tubercle of scaphoid, pisiform, tubercle of trapezium and hook of hamate
What is carpal tunnel syndrome?
Compression to the median nerve in the tunnel due to hypothyroidism, rheumatoid arthritis, pregnancy (more water retention compresses nerve), Amyloidosis etc.
It’s a very painful condition.
Congenital tissue becomes bigger.
Macroglossom (big tongue)
What are the borders of the axillary region?
Pectoralis major, latis dorsi, ribs and intercostal muscles, humerus and coracobrachialis
Where can you find the phrenic nerve?
Anterior aspect of scalene muscle (C2, C3, C4, C5)
Subclavian artery leads to?
Axillary artery -> turns to brachial artery
Sephalic vein?
Laterally located
Basilic vein?
Medially located
Pathology of rotator cuff muscles
tendinopathy of supraspinatus (baseball), CALCIFICATION, pain, tendon rupture >40 years and in younger people, avulsion of greater tubercle
Rotator cuff muscles?
SITS
What is the function of the rotator cuff muscles?
help to maintain the stability of the shoulder joint
Which are the cranial muscles inserted on the shoulder girdle?
trapezius m. and sternocleidomastoid m.
Brachial artery
clinical significance: pulse, bp
Radial injury leads to?
Wrist drop
Deep radial n. vs superficial radial n.
Deep: innervates most of back of forearm
Superficial: dorsum of hand
Retroversion is to?
Flexion
Antroversion is to?
Extension
Erb-Duchenne paralysis (C5-C6) (upper plexus and mononeuropathies)
Traction on the arm at birth or falling on the shoulder may damage the upper part of the plexus (roots may be pulled out of spinal cord)
Signs: deltoid and supraspinatus are paralyzed (no arm abduction)
Infraspinatus paralysis leads to medial rotation of the arm.
Biceps and brachialis are also paralyzed (no elbow flexion)
Loss of biceps and supinator (weak supination)
Adductors of shoulder are mildly affected (pectoralis major and lat dorsi)
**breach position coming by hand or buttocks position. C5-C6 may be actually injured
Knee jerk
L3-L4
tap on patellar ligament for patellar reflex
Hyperflexia
Exaggeration of reflex. Upper motor neuron damage
Hypoflexia
Lower motor neuron damage. No reflex
Upper motor neuron
Coming from the brain
Lower motor neuron
Coming from the spinal cord
Tip taking hand
Medial rotation of arm
Lower brachial plexus lesion
Not as common as upper plexus injuries. Paralysis of the intrinsic muscle of hand (small muscles) with anesthesia. Results from sudden upward pull of the shoulder
(C8-T1)
Klumpke’s paralysis (C8-T1)
Injury to C8-T1 roots following forced abduction of the shoulder.
Signs: Atrophic paralysis of the forearm and small muscles of the hand (CLAW HAND) and often a sympathetic palsy: eg. a Horner’s syndrome*
Ulnar n. injury
C8-T1 leads to claw hand.
Hyperextension metacarpalphalangeal joint. Flexion of interphalangeal joints
Damage to axillary n.
Supplies deltoid and teres minor
Pronator syndrome
Median n. compressed by muscle (in body builders)
Axillary injury
Abduction of the arm
Median n. injury
Papal benediction sign:
Proximal, flexor
Ape hand:
Distal and proximal. Thenar eminence will be flatten (hypothenar). (area of thumb) Fibrosis builds up
Golfer’s elbow
Medial epicondyle for flexors
Periosteal irritation, pain
Tennis elbow
Lateral epicondyle for extensors
Periosteal irritation, pain
Carpal tunnel syndrome
Compression to the median nerve in the tunnel due to hypothyroidism, rheumatoid arthritis, pregnancy, amyloidosis, etc. Very painful condition
What innervates most of the hand?
Ulnar n.
Palmar aponeurosis
Dupuytren’s contracture:
progressive fibrosis, hardening/thickening and shortening of the aponeurosis leads to partial flexion of the ring and small finger
Palmaris brevis:
In hypothenar eminence connect the skin of ulnar border to palmar aponeurosis and flexor retinaculum
Innevation: ulnar n.
Damage to radial n.
Injury proximal to the origin of triceps
No extension of elbow (elbow is flexed)
No triceps reflex
**Wrist drop (all extensor muscles and the supinator are paralyzed), thumb is flexed and adducted
**Sensory loss: dorsolateral brachial region, posterior surface of forearm, dorsum of the hand and radial side of proximal phalanges
Damage to radial n.
Injury to the nerve in radial groove
In fractures of humerus. Triceps muscle is usually functioning
WRIST DROP and sensory loss in dorsolateral aspect of the forearm and hand, plus all other problems mentioned above
Nerve injury in forearm (distal)
Deep radial n. is injured (wrist drop). Extension of the thumb and metacarpal joint is disturbed. Sensation is usually preserved
Radial n. injury
Saturday night palsy
honeymoon palsy
wrist drop
Median n. injury above the elbow
- all flexors of the wrist are paralyzed except:
flexor carpi ulnaris and ulnar part of flexor digitorum profundus - thumb flexors and abductor paralyzed but not adductor (ulnar n.)(ape hand)
- flexion at metacarpophalangeal joints possible
- 1st and 2nd lumbricals lost function and all together inability to fully flex index and middle finger
Hand of papal benediction
pronation of forearm paralyzed and sensory loss over median n. area
Injury at wrist joint
(suicide or injury e.g hand out of car’s window)
Short muscles of the thumb paralyzed, not adductor. Thenar muscles atrophy (flattened, ape hand)
Flexor pollicis longus functioning
Sensory loss over median n. area
Ulnar n. injury at wrist
- fingers are hyperextended at metacarpophalngeal joints and flexed at interphalangeal joints (claw hand)
- tendon of flexor digitorum paralyzed, therefore flexion of the ring and little finger is not possible at distal phalangeal
- abduction and adduction of the fingers are impared
- sensory loss over ulnar innervating area
Ulnar n. injury at elbow
- paralysis of flexor carpi ulnaris and medial portion of flexor digitorum profundus
- ulnar deviation of the wrist is weakened, hand is abducted and extended
brachial artery occlusion/ laceration leads to?
deep flexor paralysis
Volkmann’s ischemic contracture
Lack of blood flow to the forearm. Claw like hand
What does the axillary vein become?
subclavian vein
Lymph nodes of the axillary region
Breast cancer may give metastasis to the axillary lymph node (75% of breast’s lymphatic drain here) removal of lymph nodes may be necessary.
Mesectomy: removal of the breast
What happens to oncotic pressure in lymphatic system
oncotic pressure increases when trying to remove material from extracellular space.
Done immediately to prevent edema
What are the contents of the medial bicipital groove?
median n., brachial artery/vein, basilic vein, medial cutaneous antebrachial n. and ulnar n.
What are the contents of the cubital fossa?
Basilic v, antebrachial basilic v, cephalic v, median cubital v, medial antevrachial n, lateral antebrachial cutaneous n
What are the borders of the snuffbox?
tendon of extensor pollicis longus
tendon of extensor pollicis brevis
abductor pollicis longus
What are the contents of the snuffbox?
radial artery and superficial radial n.
Hinge joints
Monoaxial with one degree of freedom since joint movement is restricted by the two collateral ligaments around the joint. Bony ledge fits into groove of another one. Convex and concave surfaces.
Movements include flexion and extension
Ex. interphalangeal or ankle joints. Knee joint
Pivot joints
Monoaxial and have one degree of freedom. Convex and concave surfaces.
Movements include supination and pronation.
Ex. proximal and distal radioulnar joints.
Plane joints
Between two flat or slightly articular surfaces.
Make gliding movements possible.
Ex. intervertebral joints, zygoapophyseal joints
Ellipsoidal joints
Multiaxial and have two degrees of freedom. Concave and convex elliptical shaped surfaces.
Movements include flexion, extension, abduction, adduction, and circumduction (combination movement)
Ex. radiocarpal joints, wrist joint
(2 principal axis + combination movement)
Saddle (sellar) joints
Multiaxial and have two degrees of freedom. Concave and convex saddle shaped surfaces.
Movements includes flexion, extension, abduction, adduction, circumduction (combination movement).
Ex. carpometacarpal joint of the thumb
(2 principal axes)
Ball-and-socket joints
Multiaxial with 3 degrees of freedom. Convex, ball-like surface and a concave, socket-like surface.
Movements include flexion, extension, abduction, adduction, medial rotation, lateral roation, and circumduction.
Ex. hip joint, metacarpalphalangeal joint, and shoulder joint
Fontanels
Unossified remnants of the membranes in newborns. Major fontanels are: anterior (ossified within 18-36 months), posterior, mastoid and sphenoid which are ossified within 6 month or more.