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RA > L21 - Upper limb trauma > Flashcards

L21 - Upper limb trauma Flashcards

1
Q

How would you treat symptoms of bursitis?

A 
R - Rest
I - Ice 
C - Compression
E - Elevation
- Give anti-inflammatory medicine
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2
Q

What is bursitis?

A

Inflammation of bursae (fluid-filled sac or sac-like cavity)

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3
Q

Where are the most common locations for bursitis?

A
  • Shoulder
  • Elbow
  • Hip
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4
Q

What is subacromial bursitis?

A

Bursitis between rotator cuff tendons and acromion

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5
Q

When might you experience pain if you have subacromial bursitis?

A

Pain during abduction

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6
Q

What is olecranon bursitis?

A

Inflammation of olecranon bursa (lying over the subcutaneous triangular area on dorsal surface of olecranon process of ulna)
- Round fluctuating painful swelling

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7
Q

What can cause olecranon bursitis?

A
  • Repeated friction as occurs in students
  • Trauma during falls on elbows
  • Infection from abrasions of skin covering olecranon process
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8
Q

What are the presenting features of shoulder separation (acromioclavicular subluxation)?

A
  1. Injured arm hangs lower than normal (contralateral arm)

2. Noticeable bulge at tip of shoulder as a result of upward displacement of clavicle

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9
Q

How might fractures of upper limbs occur?

A
  • Falls
  • Automobile accidents
  • Sports injuries
  • Bones weakened by infection, tumour or other problems
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10
Q

What would the bandage for a fractured clavicle look like?

A

Figure of 8 bandage

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11
Q

At what point of the clavicle is a fracture most likely to occur?

A

At the junction of medial 2/3 and lateral 1/3 of the bone

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12
Q

Where can fractures occur on a humerus?

A
  1. Surgical neck
  2. Midshaft
  3. Supracondylar
  4. Medial epicondyle
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13
Q

What is an avulsion fracture?

A

Injury to the bone in a location where a tendon or ligament attaches to the bone
- Tendon/ ligament pulls off a piece of the bone

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14
Q

What is a monteggia fracture?

A

Fracture of the proximal 2/3 of the ULNA

- Dislocation of the proximal head of the radius

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15
Q

What is a galeazzi fracture?

A
  • Fracture of the middle to distal 1/3 of the RADIUS

- Dislocation of the distal radioulnar joint

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16
Q

What is a colles fracture?

A
  • Dinner fork deformity
  • Fall on outstretched hand
  • Fracture of distal radius; bent backwards
  • Dorsal angulation
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17
Q

What is a smith fracture?

A
  • Garden spade deformity
  • Fall of flexed hand
  • Fracture of distal radius
  • Palmar/ volar angulation of the distal fragment
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18
Q

What is compartment syndrome?

A

Inc pressure within a muscle compartment of limb
- Most often due to injury (e.g. fracture) that causes bleeding in muscle –> inc pressure in muscle –> nerve dmg due to dec blood supply

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19
Q

What is a scaphoid fracture and how could it occur/ complications?

A

Break of scaphoid bone in wrist

  • Fall on outstretched hand
  • Avascular necrosis of proximal segment
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20
Q

What is mallet finger (‘baseball finger’) and how could it occur?

A

Injury to thin (extensor) tendon that straightens the end joint of a finger or thumb, usually by a direct blow to finger tip
- Avulsion of distal interphalangeal joint

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21
Q

What are the main terminal branches of the brachial plexus?

A
  1. Axillary nerve
  2. Radial nerve
  3. Ulnar nerve
  4. Median nerve
  5. Musculocutaneous nerve
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22
Q

What does the axillary nerve innervate in the upper limb?

A
  • Teres minor

- Deltoid muscles

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23
Q

What does the median nerve innervate in the upper limb?

A
  • Anterior comp of forearm
  • Lumbricals of hand
  • Thenar eminence
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24
Q

What does the radial nerve innervate in the upper limb?

A
  • Posterior compartment of arm (extensors)

- Posterior compartment of forearm

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25
Q

What does the musculocutaneous nerve innervate in the upper limb?

A
  • Anterior compartment of the arm
  • Coracobrachialis
  • Biceps brachii
  • Brachialis
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26
Q

What does the ulnar nerve innervate in the upper limb?

A
  • Flexor muscles of forearm
  • Flexor carpi ulnaris
  • Flexor digitorum profundus
  • Intrinsic muscles of hand
  • lumbricals
  • Hypothenar
  • Interossei
  • Palmaris brevis
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27
Q

What nerve is injured in ‘hand of benediction’?

A

Median nerve injury

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28
Q

What nerve is injured in ‘clawhand’?

A

Ulnar nerve injury

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29
Q

What nerve is injured in ‘wrist-drop’?

A

Radial nerve injury

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30
Q

What could cause nerve injury?

A
  • Stretching or pressing on a nerve
  • Dmged as result of other health conditions that affect nerves (diabetes or Guillain-Barre syndrome)
  • Pressure on the nerve
  • Local anaesthetic toxicity
  • Ischaemia nerve injury
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31
Q

What is paraesthesia?

A

Abnormal sensation (tingling or burning)

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32
Q

What is anaethesia?

A

Loss of sensation; may be pathological or induced to facilitate surgery or other med treatment

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33
Q

What is Erb’s palsy and which nerves are affected?

A

Upper brachial plexus palsy resulting in ‘waiter’s tip position’

  • Arm hangs at the side
  • Elbow extended (arm is straight)
  • Forearm pronated
  • Hand flexed
  • C5 and C6
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34
Q

What is Klumpke’s palsy and which nerves are affected?

A

Lower brachial plexus palsy resulting in claw hand

  • Wrist flexed and fingers flexed
  • C8 and T1
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35
Q

Cause of Erb’s palsy?

A
  • Trauma; e.g. falling on shoulder
  • Traction on arm at birth (Erb-Duchenne palsy); SHOULDER DYSTOCIA (baby’s ant shoulder gets aught above mother’s pubic bone); if head and neck pulled to side at same time as shoulders pass through birth canal, can cause Erb’s palsy
36
Q

Cause of Klumpke’s palsy?

A
  • Birth injury to neck and shoulder (difficult vaginal injury)
  • Trauma to arm and shoulder
  • Tumour of lung or shoulder
  • Nerves may be stretched or torn
37
Q

What are some hard signs of vascular injury?

A
  • Active arterial (pulsatile) bleeding
  • Pulseless/ ischaemia
  • Bruit or thrill
  • Expanding pulsatile haematoma
38
Q

What are some soft signs of vascular injury?

A
  • Minor bleeding
  • Injury in proximity to major vessel
  • Small to moderate size haematoma
  • Associated nerve injury
39
Q

What is Allen’s test?

A

A test done to determine that collateral circ is present from the ulnar artery in case thrombosis occur in the radial

40
Q

What causes subacromial bursitis?

A
  • Excessive use of joint
  • Overhead lifting
  • Forceful pulling
  • Throwing/ pitching
41
Q

What is tennis elbow (lateral epicondylitis) and how can it occur?

A
  • It is a strain or tear of extensor tendons

- Repeated or violet extension of the wrist with forearm pronated leads to tenderness over lateral epicondyle of humerus

42
Q

What is golfer’s elbow (medial epicondylitis) and how can it occur?

A
  • Strain or tear of flexor tendons
  • Pain on medial side of elbow
  • Repetitive use of superficial flexors of forearm
  • Inflammation of medial epicondyle
43
Q

What is subluxation?

A

An incomplete or partial dislocation

44
Q

What could cause shoulder separation (acromioclavicular subluxation)?

A

Caused by downward blow on tip of shoulder

45
Q

Which is the most commonly dislocated joint?

A

Shoulder joint

- Commonly dislocated anteriorly and inferiorly

46
Q

What is an important complication of a shoulder dislocation?

A

Axillary nerve can be damaged

47
Q

Describe what happens in radial head subluxation (nursemaid’s elbow)

A
  • Radius pulled away from normal position (capitulum of humerus)
  • The annular ligament will then slip into the elbow joint
    (Radius may slip out partially from annular ligament)
48
Q

How might radial head subluxation (nursemaid’s elbow) occur and which age group is it most prevalent in?

A
  • Children (1-3 years old); the annular ligament is loose in young children
  • Sudden lifting/ pulling of child by their forearm
49
Q

What does the annular ligament do?

A
  • Provides sling effect around radial head

- Stabilises the radius as it rotates (supination and pronation) and articulates with the radial notch of the ulna

50
Q

How could you correct radial head subluxation (nursemaid’s elbow)?

A

Forceful supination and flexion of elbow

51
Q

In a child with radial head subluxation, which movement would be painful and limited?

A

Supination

52
Q

How could a fractured clavicle occur?

A

Direct injury or FOOSH

53
Q

Which nerve is in danger of being damaged in a supracondylar fracture of humerus?

A

Median nerve

54
Q

Which of the spinal cord nerves are included in the brachial plexus?

A

C5, C6, C7, C8, T1

55
Q

How is the brachial plexus organised starting from roots?

A 
Roots
Trunks
Divisions
Cords
Branches
56
Q

What is Saturday night palsy and which nerves are affected?

A
  • Radial nerve compression in arm resulting from direct pressure against a hard object
  • Typically following deeps sleep on arm (following alcohol intoxication)
  • Radial nerve (compression)
57
Q

Which nerve is affected in carpal tunnel syndrome?

A

Compression/ entrapment of median nerve

58
Q

What is carpal tunnel syndrome?

A
  • Pain, numbness and tingling in hand and arm

- Median nerve compressed

59
Q

What are some risk factors of carpal tunnel syndrome?

A
  • Pregnancy
  • Hypothyroidism
  • Diabetes mellitus
  • Rheumatoid arthritis
60
Q

What are some treatments for carpal tunnel syndrome?

A
  • Splinting
  • Rest
  • Surgical decompression
61
Q

What is Guyon’s canal syndrome?

A
  • Peripheral ulnar neuropathy
  • Injury to the distal portion of the ulnar nerve
  • Numbness and tingling in ring and small finger
62
Q

What are some treatments for Guyon’s canal syndrome?

A
  • Splint

- Surgical decompression

63
Q

What are some causes for Guyon’s canal syndrome?

A
  • Repetitive trauma (handle bar neuropathy)

- Cyst

64
Q

Which nerve is affected in Guyon’s canal syndrome?

A

Ulnar nerve entrapment (ulnar nerve physically trapped or pinched)

65
Q

What is Tinel’s sign?

A

A method to detect irritated nerves

  • Lightly percuss over the suspected irritated nerve
  • If positive = tingling or ‘pins and needles’ sensation will be created
66
Q

What is DeQuervain’s tenosynovitis?

A
  • Overuse syndrome with inflammation of extensor tendons of thumb
  • Pain along radial aspect of wrist - exacerbated with thumb use
67
Q

What are some examples of carpal overuse syndromes?

A
  1. Carpal tunnel syndrome
  2. Guyon’s canal syndrom
  3. DeQuervain’s tenosynovitis
68
Q

What is Finkelstein’s test?

A
  • Used to diagnose people with DeQuervain’s tenosynovitis who have wrist pain
  • Bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If cause pain on thumb side of wrist = likely DeQuervain’s tenosynovitis
  • Ulnar deviation of fisted hand produces pain
69
Q

What are some treatmnts for DeQuervain’s tenosynovitis?

A
  • Splint
  • Rest
  • NSAIDS (non-steroidal anti-inflammatory drugs)
70
Q

What is Froment’s sign?

A
  • Tests for palsy of ulnar nerve (reduced functionality and muscle weakness of pinch grip)
  • Tests strength of abductor pollicus muscle of thumb (innervated by ulnar neve)
71
Q

Where are some of the different peripheral pulses found in the upper limb?

A
  1. Axillary pulse in the axilla region
  2. Radial pulse in distal forearm
  3. Radial pulse in anatomical snuffbox
  4. Brachial pulse in mid-arm
  5. Brachial pulse in cubital fossa
  6. Ulnar pulse in distal forearm
72
Q

What structures can be found in the cubital fossa?

A

Medial –> Lateral

  1. Median nerve
  2. Brachial artery (bifurcates into the radial and ulnar artery)
  3. Tendon of biceps brachii
  4. The radial nerve
73
Q

What is the anatomical snuffbox (radial fossa)?

A

A triangular depression on the radial, dorsal aspect of the hand
- At the level of the carpal bones, specifically, the scaphoid and trapezium bones forming the floor.

74
Q

Give an example of a compartment syndrome of the forearm

A

Volkmann’s ischaemic contracture

75
Q

What is Volkmann’s ischaemic contracture?

A
  • Increased compartment pressure results in ischaemia of muscles of forearm, typically flexor compartment
  • Complication of elbow/ forearm fractures
  • Forearm muscles contract (flexors)
  • Irreversible damage in 6 hours
  • Claw-like deformity of hand
76
Q

What are some treatments for Volkmann’s ischaemic contracture?

A
  • Removal of cast

- Surgical decompression with fasciotomy

77
Q

What is fasciotomy?

A

A surgical procedure where the fascia is cut to relieve tension or pressure commonly to treat the resulting loss of circulation to an area of tissue or muscle.
- Limb-saving procedure when used to treat acute compartment syndrome.

78
Q

How will a patient describe their pain in Volkmann’s ischaemic contracture?

A
  • Complains of pain out of proportion of injury
  • Digit swelling
  • Paresthesias
79
Q

What is Horner’s syndrome?

A
  • Damage to sympathetic nerves of face

- Affects eyes and part of face

80
Q

What are some symptoms of Horner’s syndrome?

A
  • Drooping eyelid
  • Dec sweating on affected side of face
  • Dec pupil size
81
Q

What could be some possible causes of Horner’s syndrome?

A
  • Stroke
  • Tumour
  • Injury
  • Underlying disease affecting sympathetic nerves
82
Q

What neurotesting manoeuvre could you do to test the ulnar nerve?

A
  • Peace sign against resistance

- Star (stretch fingers apart from each other)

83
Q

What neurotesting manoeuvre could you do to test the radial nerve?

A

Thumbs up

84
Q

What neurotesting manoeuvre could you do to test the median nerve?

A
  • ‘Power to the people’

- Clenched fist upwards (thumb not tucked into fingers)

85
Q

What neurotesting manoeuvre could you do to test the anterior interosseous median nerve?

A

OK sign

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