Final Exam Flashcards

Question

Presentation: Long Thoracic Nerve Palsy

Answer 1

* Pain on flexing fully extended arm and inability to do so * Winging starting at 90 degrees forward flexion * Magee Text * paralysis of the serratus anterior, causing winging (medial border) of the scapula and pain and weakness on forward flexion of the extended arm. * Abduction above 90° is difficult because of scapular winging. * Stabilization of the scapula by the examiner enables the patient to further abduct the arm.

Answer 2

* The patient is seated or standing. * The examiner stands behind patient and grasps under the forearms, holding the elbows at 80 degrees of flexion with the forearms and wrists in neutral. * The examiner leans the patient’s trunk posteriorly and passively elevated the shoulder girdle. This position is held for up to 3 minutes. * The test is positive when paresthesia and/or numbness (release phenomenon) occurs, including reproduction of symptoms.

Answer 3

* Motor: * Pronation weak or lost * Weak wrist flexion and abduction * Radial deviation at wrist lost * Inability to oppose or flex thumb * Weak thumb abduction * Weak grip * Weak or no pinch (ape hand deformity) * Sensory * Palmar aspect of hand with thumb, index, middle, and lateral half of ring finger * Dorsal aspect of distal third of index, middle, and lateral half of ring finger

Answer 4

* Motor: * Weak wrist flexion * Loss of ulnar deviation at wrist * Loss of distal flexion of little finger * Loss of abduction and adduction of fingers * Inability to extend second and third phalanges of little and ring fingers (benediction hand deformity) * Loss of thumb adduction * Sensory * Dorsal and palmar aspect of little and medial half of ring finger

Answer 5

* Motor: * Loss of supination * Loss of wrist extension (wrist drop) * Inability to grasp * Inability to stabilize wrist * Loss of finger extension * Inability to abduct thumb * Sensory: * Dorsum of hand (lateral two- thirds) * Dorsum and lateral aspect of thumb * Proximal two-thirds of dorsum of index, middle, and half ring finger

Answer 6

* Raynaud disease produces a cold, mottled, painful hand. * It is an idiopathic vascular disorder characterized by intermittent attacks of pallor and cyanosis of the extremities brought on by cold or emotion.

Answer 7

* History of traumatic event * Hypersensitivity * Pitting edema * Trophic changes including brittle nails, course hair growth, erythema * Poor response to analgesics

Answer 8

* Must Have: * Knee Pain * Radiographic osteophytes * Must also have at least one of these * age over 50 * morning stiffness less than 30 minutes * crepitus with motion

Answer 9

* Extensor carpi radialis longus * extensor carpi radialis brevis * extensor carpi ulnaris * extensor digitorum * extensor indicis

Answer 10

* Flexor Carpi Radialis * Flexor Carpi Ulnaris * Palmaris Longus * Flexor Digitorum Superficialis * Flexor Digitorum Profundus (assists) * Flexor Pollicis Longus (assists)

Answer 11

* Motor: * The patient is not able to flex the thigh on the trunk or extend the knee. The deep tendon knee reflex is also lost. Wasting of the quadriceps is most evident. * Sensory loss: * medial aspect of the distal thigh (anterior femoral cutaneous nerve) * medial aspect of the leg and foot (saphenous nerve)

Answer 12

* Motor: * hip adduction is affected, as are knee flexion (gracilis) and hip lateral rotation (obturator externus). * Sensory: * deficit is small, involving a small area in the middle medial part of the thigh, although the patient may complain of pain from the symphysis pubis to the medial aspect of the knee.

Answer 13

* Motor: * If it is injured in the pelvis or upper femur area (e.g., posterior hip dislocation), the hamstrings and all muscles below the knee can be affected. The result is a high steppage gait with an inability to stand on the heel or toes. * There is sensory alteration in the entire foot except the instep and medial malleolus, along with muscle atrophy. Usually, the symptoms are primarily in the common peroneal branch of the sciatic nerve. * In the hip region, the sciatic nerve may be compressed by the piriformis muscle (piriformis syndrome). * If piriformis is affected, there is pain and weak- ness on abduction and lateral rotation of the hip (sign of Pace and Nagel). The pain on passive medial rotation of the extended hip (Freiberg sign) is also elicited, because this action stretches the piriformis. * Sensory: Burning pain and hyperesthesia may be felt in the sacral and/or gluteal region as well as in the sciatic nerve distribution. Medial rotation with flexion of the hip accentuates the problem.

Answer 14

* Motor Weakness: * none * Sensory * medial knee pain (burning) that is aggravated by walking, standing, and quadriceps exercises