Gross: Clinical Aspect Exam 2 Flashcards
Trapezius Palsy
- Weakening of Trapezium Muscle - shoulder drops on affected side
- Due to whiplash (hyperextension/flexion of neck)
- Damage to Cranial Nerve XI (Spinal Access. Nerve)
- Test: Shrug shoulders against resistance
Lumbar Triangle
- Common site of Posterior Abdominal Hernia
- Borders: Iliac Crest, Latissimus Dorsi, External Oblique
Triangle of Auscultation
- Used to take lungs to be heard
- Borders: Trapezius, Latissimus Dorsi, and Vertebral Border of Scapula
- Gets larger when scapula is abducted
Long Thoracic Nerve Palsy AKA Winged Scapula Syndrome
-Weakening of Serratus Anterior
-Hard to hold scapula flat to abdominal cavity
-Causes: Trama/sublux
Traction inj to shoulder (inc angle of neck and shoulder.
Recumbancy- laying back or side long pd time due to surgery
Crutch Paralysis
Weakening of Deltoid Muscle due to damage to Axillary Nerve.
- Weakened ABduction of humerus
- May have loss of sensation of lateral Arm
- Causes: Fraction of surgical neck of humerus
- Dislocation of shoulder joint
- Pressure of crutch in axilla.
Rotator Cuff Tendonitis aka shoulder Impingement Syndrome
- Most Common Shoulder pain/Inflammation of supraspinatus tendon.
- Pain in ant/lat aspect shoulder & arm.
- weaker than normal…Twinge in shoulder area –> Pain during/after activity..hot/burning…
- Causes: Born w/ hooked acromion Process
- Weakness around rotator cuff, humerus rides up and compresses tend.
- Stress/Repetition (athletes)
- Ca++ deposits in tendon in elderly
Rotator Cuff Tears
- Rupture of rotator cuff tendon at/near insertion.
- Symptoms similar to tendonitis BUT difficulty ABducting arm.
- Young: Single traumatic Injury (Shoulder dislocation)
- 50+: minor trauma
- Age, Repeated Trauma, Steroid = tear
- Drop Test: Slowly lower limb, drops quick last 30-40 due to supraspinatus
Drop Test
- Evaluates rotator cuff tears.
- Pt slowly lowers fully ABducted arm and it goes smooth until last 30-40 degrees where it quickly drops. Then tear indicated (supraspinatus)
Bursitis (rotator cuff)
Inflammation in deltoid and/or subacromial bursae. More common than rotator cuff tendonitis
Quadrilateral Space
- Axillary Nerve and Humeral Circumflex Arteries go through it.
- Borders: Teres Minor, Teres Major, Long Head of Triceps Brachii, Humerus
Triangular Space
- Circumflex Scapular branch of sub scapular Artery
- Teres Minor, Teres Major, Long head of Triceps Brachii
Shoulder Separation
- Dislocation at AC joint.
- Shoulder Pointer = common cause. blow to shoulder
- Contact Sports
- Grade III dis: both AC and Coracoclavicular ligs rupture and clavicle will sep. from scap.
- Lat. end of clavicle displaced easily palpable - Acromion Process more prominent (Acromion bump)
- Sometimes subclavian artery compromised and indicated by diminished brachial and radial pulse.
- Healed tear not as strong as log b4 injury
Shoulder Dislocation
- Dislocation of glenohumeral joint
- Anterior dislocation most common
- May damage Musculocutaneous and Axillary N
- Loss sensation lateral A/FA - Most common type:: Anterior Dislocation at inferior aspect of capsular lig. (moves medial and inferior) Caused by excessive extension and lateral rotation of humerus.
- Subcoracoid Dis: head humerus forced through ant part of capsular lig. and ends up lying below coracoid process.
- Shoulder Lose rounded appearance & greater tuberosity can’t be palpated normal position.
Bicipital Tendonitis
- Inflammation of Long head of Biceps Brachii with/in intertubercular groove.
- Causes: Wear/Tear = inflammation
- When lots flexion against resistance at elbow jt.
- Some narrow/rough groove…cracking called Creptis
- Pain proximal Arm/Shoulder
Rupture of Biceps Tendon
-Popeye Syndrome
-Rupture near supraglenoid attachment of biceps muscle.
-Detached muscle belly forms ball on distal/ant. arm = Popeye deformity
Causes: Wear and Tear = chronically inflame.
-Forceful Flexion FA against resistance and chronic tendonitis.
-Normally ruptures at Origin..If Insertion then trauma
Biceps Reflex
Tests segmental Innervation C5 & C6
Tendon of Insertion tap biceps tendon
Triceps Reflex
Tests Segmental Innervation C7 & C8
Cubital Fossa
From Medial and Lateral Epicondyles form sup. border...then brachioradialis and Pronator Teres. Contains: Median Nerve
Brachial Artery
Median Cubital Vein
Biceps Tendon
1 of every structureCarrying Angle
- Women (~12-15) have > angle than Men (~5)
- Lateral angle b/w ulna and humerus
Cubitus Valgus
Abnormal Increase in Carrying Angle
Subluxation Radial Head
(Nursemaids elbow)
Pulled/Slipped Elbow
Radius slips out of annular ligament
- From sudden pulling on arm/hand
- Symptoms:
- Very painful
- Held in pronated flexed FA at side
- Palpation shows tender radial head
- Supination FA = very painful
Colle’s Fracture
FOOSH (fall on outstretched hand)
- Fall forward on hand (FA pronated). Force travels up hand to distal radius.
- Distal Fragment of radius moves posteriorly
- Dinner Fork Deformity
- One of most common fractures in adults especially women +50 (osteoporosis)
- Heals quickly = good vascularization
- If not healed correctly:
- Flexion Extension at wrist limited
- Traumatic Arthritis of wrist joint
Smith’s Fracture
FOOSH
-Distal end radius displaced anteriorly due to falling on back of hand
Boxer’s Fracture
Fracture of 5th metacarpal. Punching with closed fist
Most commonly fractured carpal bone
Scaphoid
Scaphoid Fracture
- Most common fractured carpal bone
- Fall on palm with hyperextended hand
- twice as much force needed to fracture this compared to radius
- May think sprained wrist
- Pain/swelling in snuffbox
- Lead to necrosis to proximal part of bone and lead to degenerative arthritis of wrist jt
Hamate Fracture
- Golf club shoved into hand.
- ulnar nerve may be injured due to hook of hamate
Phalange Fractures
Crushing injuries (caught in door)
Pronator Teres Syndrome
- Similar to Carpal Tunnel Syndrome
- Median Nerve b/w two Pronator Teres heads
- Direct Trauma
- Excessive Pronation/Supination
Ulnar Deviation
Weakness of Flexor Carpi Radials causes more medially favored flexion of hand
Radial Deviation
Weakness of Flexor Carpi Ulnaris causes more laterally favored flexion of hand
Ape Hand
Median Nerve damage causes atrophy of thenar muscles. Thumb held close to 2nd metacarpal.
-No opposition (thumb to pinky)
What two syndromes are a result of median nerve damage?
Pronator Teres Syndrome (proximal FA) ; Carpal Tunnel Syndrome (Distal FA)
Median Nerve Damage Symptoms
- Loss/weakened Pronation
- Abnormal/weak flexion at wrist (ulnar dev.)
- Atrophy of thenar muscles –> Ape Hand
- Sensory loss lat. 2/3 of palmar surface
Median Nerve Damage Tests:
Motor Test: make circle with thumb and index finger. Doctor try to pull 1st digit away from 2nd digit by applying force to proximal phalanx of digit 1. Checking for strength of thenar muscles.
-Also check strength of flexion at wrist joint and joints of digits
Sensory Test: Cutaneous sensation of tip of 2nd digit (least susceptible to variation of other digits nerve supply)
Claw Hand
Ulnar Nerve damage. Can’t fully flex digits 4 & 5.
Ulnar Nerve Damage Symptoms
- Impaired/weakened adduction of hand
- Radial Deviation (weakened flex.)
- hypothenar muscles atrophy
- Can’t make fist well (claw hand)
Guyon’s Tunnel/Canal Syndrome
-Compression of ulnar nerve b/w Pisiform and Hook of Hamate
-Symptoms: Loss sensation 1 1/2 digits
May have atrophy of hypothenar muscles
-Cyclists/Handlebar Neuropathy = when developed due to bicycling with hands hyperextended against hand grips
Tennis Elbow
AKA
Lateral Epicondylitis
- Repetitive use superficial post. FA muscles with common origin of Lateral Epicondyle
- Gradual onset –> severe pain that limits activities
- Pain at lateral epicondyle radiating down lateral aspect of FA
- Full extension at wrist jt increases pain
- Test: Extend hand at wrist joint against resistance. There will be pain at lateral epicondyle
What else will cause pain at the lateral epicondyle other than Tennis Elbow?
Inflammation/Subluxation at C5
Mallet/Baseball Finger
Avulsion Fracture to extensor on distal phalynx. Causes flexion at DIP jt and it resembles a mallet
DeQuervain’s Disease
AKA
Tenosynovitis Stenosans
Inflammation of tendons Abductor Pollicis Longus and Extensor Pollicis brevis in their common sheath.
- May be due to repetitive hand wrist movements (friction)
- Common women 50+ hormones
- Pain with ABduction and Extension 1st digit
- Pain of lateral wrist may radiate up FA or down thumb.
Damage to Radial Nerve
- Degree of motor paralysis depends on how bad nerve is injured (how deep)
- Fracture at shaft of humerus (most common cause)
- triceps may be spared but post. FA muscles affected
- Sensation post. A/FA/dorsum of hand affected
- Difficulty extending hand/digits. - Hand drops to passive flexion (Wrist Drop)
- Deep damage in FA: affects motor: extension in hand/digits.
- Superficial Damage in FA: Sensory loss No Motor
Wrist Drop
Damage to radial nerve in shaft of humerus break.
-Hand will drop into passive flexion
Carpal Tunnel Syndorme
AKA
Distal Median Nerve Neuropathy
- Compression of median nerve here mostly due to (6): (Emmas Fam Tries Out Regular Mma)
- Edema (swelling from fluid) obesity/prego.
- Fractures: Smith’s Fracture
- Tumors: ganglionic cyst
- Oral Contraceptive - (hormones)
- Repetitive Flex/Ext of wrist
- Misalignment of bones
Tests referencing Carpal Tunnel Syndrome:
Tinel’s Sign &; Phalen’s Test
Tinel’s Sign
Sensation “pins & needles” over site of median nerve distribution in hand when one taps over anterior wrist
Phalen’s Test
(Praying upside down) Reproduces symptoms of CTS when patients hand maximally flexed and held in position
Dupuytren’s Contracture
- Shortening, thickening and hypertrophy of palmar aponeurosis
- 1 or + painful nodules in fascia usually @ MP jt of digits 4 & 5 (usually bilateral)
- Causes contracture of muscles that affect MP jts of those digits
- May be genetic. no cause known
- More common patients (men) over 50
- Alcoholism and epilepsy have higher incidence
Skier’s/Gamekeepers Thumb
Rupture or Laxity of ulnar collateral ligament of 1st MP jt. May be result of hyperABduction
-If severe enough may result in avulsion fracture of head of 1st metacarpal
