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Anatomy II > Lesions of UE > Flashcards

Lesions of UE Flashcards

1
Q

What parts of the brachial plexus are affected in a C5, C6 lesion?

A

Superior Trunk
Posterior and Anterior Division
Lateral and Posterior Cord
Axillary Nerve
Median Nerve
Musculocutaneous N
Radial N

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2
Q

In a C5/C6 Lesion, what is there a loss of?

A

Biceps Brachii
Deltoid
Brachialis
Supra and Infraspinatus
Rhomboids

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3
Q

What is a C5/C6 Lesion called?

A

Erb-Duchenne/Erb’s Palsy
Arm is down and pronated
“Waiters Tip” posture

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4
Q

What structures of the brachial plexus are affected in a C8, T1 lesion?

A

Inferior Trunk
Anterior and posterior divisions
Posterior and Medial Cord
Ulnar nerve
Axillary Nerve
Median Nerve
Radial Nerve

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5
Q

What is a C8/T1 lesion called?

A

Klumpke’s Palsy

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6
Q

What does a C8/T1 Lesion result in a loss of?

A
  • All intrinsic muscles of the hand including lumbricals
  • Flexor cari ulnaris
  • Results in weakness of flexor digitorum profundus
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7
Q

What position does the hand go into with Klumpke’s Palsy?

A

Due to loss of lumbricals, the MP joints will be extended and the IP joints flexed
“monkey claw hand”

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8
Q

What is a posterior cord lesion called?

A

“crutch palsy?

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9
Q

Posterior cord lesion/crutch palsy results in the loss of what?

A

Extensors of the arm, forearm and hand
* if axillary nerve is affected, shoulder abduction will be weak also

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10
Q

What is the resultant posture of crutch palsy called?

A

wrist drop

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11
Q

what can crutch palsy also be caused by?

A

radiation fibrosis

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12
Q

What can cause axillary nerve lesions?

A
  • crutch injuries
  • fracture of the surgical neck of the humerus
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13
Q

What does axillary nerve lesion result in?

A
  • motor loss in deltoid and teres minor muscles (weakness of shoulder abduction and lateral rotation of the arm)
  • Sensory loss: parathesia in the superior and lateral arm
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14
Q

Long thoracic nerve lesion

A
  • caused by external pushing, shoving or crush injury
  • results in scapular winging
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15
Q

radial nerve lesion

A
  • “Saturday Night Palsy”
  • loss of extensors to forearm, hand and fingers
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16
Q

What is the resultant posture of radial nerve lesion?

A

“wrist drop” with weakness in ab and adduction of the wrist

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17
Q

What can an injury to the radial nerve within the forearm result in?

A

Injury to deep branch of radial nerve
- inability to extend thumb and metacarpophalangeal joints
- No sensory nerve loss
- weakened supination, wrist extension, ulnar deviation

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18
Q

Musculocutaneous Nerve Lesion

A
  • rarely damaged
  • loss of all muscles in the anterior compartment of the arm
  • Weakness of arm and forearm flexion and supination
  • loss of sensation along lateral forearm
  • decreased or absent bicep tendon reflex
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19
Q

What does a median nerve lesion result in?

A
  • loss of pronation, opposition of thumb
  • weakness of flexion of all PIP and DIP and MP joints of digits 2 and 3 (FDS, FDP, and Lumbricals 1 and 2)
  • weakness of radial deviation
  • sensory loss to radial half of palm and palmar surfaces of 3 1/2 digits
20
Q

What is the resultant posture of median nerve lesion called?

A

ape hand
- If patient is asked to make a fist, digits 2 and 3 remain extended (“hand of benediction”)
- Hand lies supinated and deviated to ulnar side

21
Q

Where is a common site for entrapment of the median nerve ?

A

between the two heads of the pronator teres

22
Q

Injury to the ulnar nerve can occur in 4 places:

A
  • medial epicondyle
  • cubital fossa between heads of FCU
  • ulnar tunnel
  • Hand
23
Q

Injury at the elbow results in:

A
  1. Weakness of wrist flexion and ulnar deviation (FCU)
  2. Weakness of ulnar deviation
  3. Loss of flexion of distal phalanges of ring and little fingers (ulnar ½ FDP).
  4. Loss of abduction, adduction of fingers at MCP joints (interossei).
  5. Loss of thumb adduction (Adductor pollicis). 6. Atrophy and loss of fuction of hypothenar muscles (FDMB,ADM,ODM).
  6. Loss of sensation over ulnar side of palm and 1 ½ fingers.
  7. Failure of the fingers to flex at the MCP or extend at IP joints, especially ring
    and little finger. (interossei and lumbricals) producing an “ulnar claw” hand
24
Q

Ulnar nerve lesion results in:

A
  • Loss of ab- and adduction of digits 2-5, adduction of thumb
  • Resultant posture is called “claw hand” due to the fact that digits are extended at MP and flexed at IP joints – most profound for digits 4 & 5
25
Q

Explain the “claw hand” deformity

A
  • due to loss of ulnar nerve
  • The unopposed extensor digitorum pulls the MCP joints into hyperextension. (interossei and lumbricals ulnar ½).
  • A patient would be unable extend the IP joints when trying to straighten the fingers
  • The lesion may be most pronounced at the little and ring fingers since the lumbricals on the radial ½ of the hand would be intact
26
Q

fracture of the humeral surgical neck affects:

A

the axillary nerve

27
Q

humeral midshaft fracture affects

A

radial n

28
Q

fracture at medial epicondyle affects

A

ulnar nerve

29
Q

3 layers of the integument

A

epidermis
dermis
hypodermis

30
Q

epidermis

A
  • Tough, leathery outer
    layer of skin
  • .06-.6 mm in thickness
  • 5 layers
  • Avascular
  • Regenerates every 14-
    21 day
31
Q

5 layers of the epidermis

A
  • Stratum Basale * Stratum Spinosum * Stratum Granulosum * Stratum Lucidum * Stratum Corneum
32
Q

stratum basale

A
  • Single row of keratinocytes
  • Deepest layer
  • Attached to dermis via basement membrane
  • Diffusion through the basement membrane is how the epidermis receives nutrition
33
Q

Status Spinosum

A
  • Several rows of mature keratinocytes
  • Appear spiny due to keratin filaments
34
Q

Stratum Granulosum

A
  • 3-5 rows of flattened cells
  • ↑keratin concentration
35
Q

Status Lucidum

A
  • Few layers of flattened
  • Dead keratinocytes
  • Only found on soles of feet and palms
36
Q

Stratum Corneum

A
  • Outer most layer
  • 20-30 cells thick
  • ¾ of the thickness of epidermis
37
Q

Cell types

A

Melanocytes
Merkle Cells
Langerhan’s Cells
Fibroblasts

38
Q

Hair follicles

A
  • Soft keratin
  • Found everywhere except palms and soles of feet
  • regulates body temperature
39
Q

every hair follicle has a what

A

sebaceous gland that secretes sebum

40
Q

sudoriferous glands

A

– Present everywhere except lips and ears
– Secretes sweat into ducts
– Helps decrease growth of bacteria

41
Q

nails

A
  • dorsal tips of digits
  • hard keratin
42
Q

dermis

A

2-4 mm thick
layers less defined than epidermis

43
Q

2 layers of dermis

A

papillary
reticular

44
Q

papillary layer of dermis

A

– Superficial layer
– Loosely woven fibers with ground substance
– Ridges and valleys
– Where blisters occur

45
Q

reticular layer of dermis

A

– Dense irregular CT
– Deepest layer
– Gives structural support

46
Q

stages of tissue repair

A
  • Hemostasis (5-10 minutes) –> Vasodilation
  • Inflammatory phase (12 hrs to 4 days) –> Macrophages & neutrophils ; general damage assessment and cleaning of the wound
  • Proliferative Phase (3-16 days) –> Fibroblasts; general prepping of wound bed and beginning of epithelialization
  • Maturation Phase (21+ days) –> Tissue remodeling
47
Q

Scapulohumeral Rhythm

A

– First: 0-15 abduction: GH only = prime mover = supraspinatus
– 15-30 degrees: GH joint but now deltoid helps supraspinatus
– 30-120 abduction = scapula really starts to rotate upwardly; GH joint too; GH just by supraspinatus and deltoid; Scap upwardly rotating with upper trap and serratus; posterior rotation of clavicle somewhere between 90 and 120
– 120-180 = scapula and GH joint  lower fibers of trap kicks in to finish the upward rotation but all other previous muscles are still on

Anatomy II (8 decks)

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