Module 1: Clinical Application Flashcards
scapula moved laterally and lower medial border and inferior angle are raised
RHOMBOID PALSY:
scapula moved laterally and lower medial border and inferior angle are raised
Describe Trapezius palsy treatment:
surgically with muscle transfers of levator scapulae and rhomboids
scapula moved laterally and lower medial border and inferior angle are raised
RHOMBOID PALSY:
scapula moved laterally and lower medial border and inferior angle are raised
TREATMENT FOR?
TRAPEZIUS PALSY TREATMENT: levator scapulae is moved to the scapular spine, rhomboids moved to the posterior inferior scapula.
stretching or microscopic tearing of muscle fibers
strain
most common back muscle (group) that is strain?
erector spinae (SLI muscles) group (d/t improper lifting technique, poor conditioning)
only ligamentous tissue is involved in this injury
sprain
most common sprain of the back?
anterior longitudinal ligament
Cause of shoulder impingement:
Inflammation and calcification of the subacromial
bursa (calcific scapulohumeral bursitis)
Characteristic pain
pain during 50-130 degrees of abduction
Explain what causes the pain associated with shoulder impingement
Tendon of supraspinatus AND
the acromion compresses the subacromial bursa
cause of GH joint anterior dislocation:
cause of GH joint anterior dislocation: Excessive extension and lateral rotation of the humerus OR forceful blow to the posterior shoulder of an abducted humerus
cause of GH joint anterior dislocation: in simple terms
humeral head is displaced from glenoid cavity
Characteristic of GH joint anterior dislocation:
Damage to axillary nerve and posterior circumflex humeral artery
Shoulder separation cause:
Separation of the acromioclavicular joint as a result of a downward force being applied to the superior part of the acromion
Three types:
- Torn AC ligament
- Torn AC w/ separation
- Torn AC, trapezoid and conoid ligaments w. separation
Is shoulder separation a dislocation of the glenohumeral joint?
Shoulder separation is
NOT a dislocation of
the glenohumeral joint
most common tendon tear associated with rotator cuff tears
supraspinatus most common tendon tear
Characteristic pain of rotator cuff tear
pain when arm is overhead and weakness
How is rotator cuff tear tested for supraspinatus
drop arm test: abduct arm fully, lower arm slowly w. control
After, 90degrees the arm will drop more quickly than the unaffected side
Prolonged head turning may reduce blood flow to the ______ artery (brain), causing light-headedness, dizziness, etc.
Prolonged head turning may reduce blood flow to the vertebral artery (brain), causing light-headedness, dizziness, etc.
Cause: ___ part of tubercle is torn away d/t a fall onto the ____ OR fall on the hand when arm is ______
Small part of tubercle is torn away d/t a fall onto the acromion OR fall on the hand when arm is abducted
Characteristic: Arm is pulled ____ by muscles still attached (_____)
Arm is pulled medially by muscles still attached (subscapularis)
Cause of axillary nerve injury
May be compressed d/t an anteroinferior shoulder dislocation
Characteristic: Inability to ____ arm to or ____ horizontal (_____ muscle compromised)
Sensory loss on _______ aspect of ____
Inability to abduct arm to or above horizontal (deltoid muscle compromised)
Sensory loss on superolateral aspect of arm
Axillary nerve injury
Nerves of the scapular region: List the (3)
- Axillary nerve (C5-C6)
- Upper sub scapular nerve (C5-C6)
- Lower sub scapular nerve (C5-C6)
Cause of clavicle fracture:
direct fall on the shoulder; indirect due to the transmission of force from arm and forearm to shoulder during a fall on an outstretched hand
Presentation of clavicle of fracture:
Medial fragment is elevated d/t SCM;
Lateral fragment is depressed d/t weight of arm and adducted and pulled medially d/t pectoralis major.
Lymph from the nipple, areola, and lobules travels through the?
subareolar plexus
superior + inferior quadrants of the breasts accounts for 75% of lymph drainage to the ____ lymph nodes
superior + inferior quadrants of the breasts accounts for 75% of lymph drainage to the the axillary lymph nodes
Medial quadrants drain into the ____ lymph nodes
Medial quadrants drain into the parasternal lymph nodes
_____ lymph nodes can send lymph to the contralateral breast
Parasternal lymph nodes can send lymph to the contralateral breast
Inferior quadrants of the breast can send lymph to the ____ nodes
Inferior quadrants of the breast can send lymph to the sub-diaphragmatic nodes
Presentation of breast cancer: glandular tissue is invaded
Large dimples, shortening of suspensory ligaments
Presentation of breast cancer: lactiferous ducts invaded
Retraction and deviation of nipple, shortened ducts, common in subareolar breast cancer
Presentation of breast cancer: lymphatic drainage invasion
Lymphedema (excess fluid in subcutaneous tissue)
Peau d’orange sign (orange peel appearance) Prominent/puff skin between dimpled pores
Breast cancer presentation: Retromammary space, pectoral fascia, interpectoral lymph nodes invaded
Breast elevates when muscle contracts; sign of advanced breast cancer
Humeral shaft fracture:
- Transverse fracture: Proximal fragment is pulled _____ by (deltoid)
Humeral shaft fracture:
- Transverse fracture: Proximal fragment is pulled medially by (deltoid)
Humeral shaft fracture:
- Spiral fracture: may result in _______ (overriding end)
Humeral shaft fracture:
- Spiral fracture: may result in shortening (overriding end)
Humeral shaft fracture: results in radial nerve (in radial groove)
Humeral shaft fracture: results in radial nerve injury (in radial groove)
Surgical neck fracture: common in ______ and causes ____ nerve injury
Surgical neck fracture: common in elderly and causes axillary nerve injury
Distal humerus fracture can cause ____ nerve injury (intercondylar or supercondylar fracture)
Distal humerus fracture can cause median nerve injury (intercondylar or supercondylar fracture)
Elbow dislocation: can result in the “terrible triad” injury
1. _____ dislocation
2. ____ head fracture
3. ______ process fracture
Elbow dislocation: can result in the “terrible triad” injury
1. elbow dislocation
2. radial head fracture
3. coronoid process fracture
Characteristic of elbow dislocation in 80-90% is the radius and ulna dislocated (anteriorly/posteriorly) to humerus
Characteristic of elbow dislocation in 80-90% is the radius and ulna dislocated posteriorly to humerus
Risk of _____ nerve injury (most common) and ____ nerve injury in elbow dislocation
Risk of ulnar nerve injury (most common) and median nerve injury in elbow dislocation
Nursemaid’s elbow is also known as ____ and _____ of the ____
Nursemaid’s elbow is also known as subluxation and dislocation of the radius
Characteristic of subluxation and dislocation of radius: muscle pulls radial head (inferiorly or superiorly); tenderness due to pinched ______ ligament by radial head against ______
Characteristic of subluxation and dislocation of radius: muscle pulls radial head superiorly; tenderness due to pinched annular ligament by radial head against capitulum
What is the injury?
Location of injury: “wear and tear” over the intertubercular sulcus; “popeye deformity”
Rupture of tendon of Long Head of Biceps Brachii:
What is the injury?
Symptoms: audible snap/pop, bulge in center of distal anterior arm pain and tenderness at shoulder
Common in males 40-60yo
Rupture of tendon of Long Head of Biceps Brachii:
How is the muscle displaced in rupture of tendon of long head of biceps brachii injury?
distally displaced
What is the injury: audible snap/pop, bulge in center of proximal anterior arm, pain at elbow; palpable soft mass proximally displaced
Rupture of distal biceps brachii tendon: rare 3% of ruptures
What is the injury?
Location of injury: torn from radial tuberosity, can be an avulsion fracture
Rupture of distal biceps brachii tendon: rare 3% of ruptures
How is the muscle displaced in rupture of tendon of distal biceps brachii tendon injury?
Proximally displaced
Ischemia of Elbow and Forearm “Volkmann’s Contracture”:
sudden ______ artery occlusion/laceration; collateral pathways only help in gradual and ______ occlusion
Ischemia of Elbow and Forearm “Volkmann’s Contracture”:
sudden brachial artery occlusion/laceration; collateral pathways only help in gradual and partial occlusion
Muscles can tolerate up to ___ hours of ischemia; fibrous tissue replaces necrotic tissue,
Muscles can tolerate up to 6 hours of ischemia; fibrous tissue replaces necrotic tissue,
Result of ischemia to brachial artery: ____ of fingers + wrist; loss of hand _____
Result of ischemia to brachial artery: contraction of fingers + wrist; loss of hand power
Injury to musclulocutaneous nerve results in:
- _____ flexion at _______ joint
- _____ flexion and ______ at ______ joint
- Loss of sensation in the _____ aspect of the forearm
Injury to musclulocutaneous nerve results in:
- Weak flexion at glenohumeral joint
- Weak flexion and supination at elbow joint
- Loss of sensation in the lateral aspect of the forearm
Injury to the radial nerve superior to the origin of the triceps results in:
______ of all muscles of supplied by the radial nerve
Injury to the radial nerve superior to the origin of the triceps results in:
Paralysis of all muscles of supplied by the radial nerve
Injury in the radial groove results in:
paralysis of ____ head of triceps and all ______ muscles of forearm _____to the site of nerve lesion;
- elbow extension _____ but not lost (lateral +long heads not affected)
Injury in the radial groove results in:
paralysis of medial head of triceps and all posterior muscles of forearm distal to the site of nerve lesion;
- elbow extension weakened but not lost (lateral +long heads not affected)
What protects the brachial artery and median nerve during venipuncture?
Bicipital aponeurosis
Claw hand occurs anywhere C_ and T_ axons are damaged
Claw hand occurs anywhere C8 and T1 axons are damaged
Damage to ulnar nerve at elbow results in patient unable to _____ the distal interphalangeal joint, making ____ hand more prominent
Damage to ulnar nerve at elbow results in patient unable to flex the distal interphalangeal joint, making “claw” hand more prominent
Damage to ulnar nerve at the wrist results in the patient unable to ___ metacarpophalangeal joint and move digit _.
Damage to ulnar nerve at the wrist results in the patient unable to flex metacarpophalangeal joint and move digit 5.
C8 ande T1 axons are damaged… which nerve are you concerned about?
Ulnar nerve
Damage to the ulnar nerve at the elbow affects which muscles
medial half of flexor digitorum profundus in addition to the hypothenar muscles, 3rd and 4th lumbrical and interossei
Damage to the ulnar nerve at the wrist affects which muscles
paralysis of hypothenar muscles, 3rd & 4th lumbricals, and interossei
Does damage to the ulnar nerve affect the ability to flex at the proximal interphalangeal joint
NO, it affects the distal interphalangeal (damage at elbow) or metacarpophalangeal joint (damage at wrist.
Flexor digitorum (responsible for flexion at the PIP joint) is innervated by median nerve
Symptoms of claw hand deformity:
- sudden severe onset of pain on ___ of _____
- _____ and _____ in forearm and __ & ____ digits;
- ___ nerve irritation or injury
Symptoms of claw hand deformity:
- sudden severe onset of pain on inside of elbow
- numbness and tingling in forearm and 4th & 5th digits;
- ULNAR nerve irritation or injury
Causes of Claw Hand: Avulsion Fracture of Medial Epicondyle
- Usually affects _____ age _ to __ years old
- ______ (sport)
- Fall causing severe _____ of an extended elbow
Causes of Claw Hand: Avulsion Fracture of Medial Epicondyle
- Usually affects children age 9 to 14 years old
- Pitchers (sport)
- Fall causing severe abduction of an extended elbow
Sensory territory of median nerve
Supracondylar fracture of humerus:
- mechanism of injury: fall onto outstretched hand
- Clinical implications:
a) ____ shaft fragment displaced anteriorly/posteriorly (limb shortening)
b) risk of ____ artery laceration (ischemic contracture)
c) risk of ____ nerve damage (Volkmann’s) –> motor & sensory loss (Hand of Benediction when making a fist)
Supracondylar fracture of humerus:
- mechanism of injury: fall onto outstretched hand
- Clinical implications:
a) DISTAL shaft fragment displaced posteriorly (limb shortening)
b) risk of BRACHIAL artery laceration (ischemic contracture)
c) risk of MEDIAN nerve damage (Volkmann’s) –> motor & sensory loss (Hand of Benediction when making a fist)
Pronator syndrome
____ nerve contrapment;
Symptoms:
a) pain and tenderness in the proximal anterior/posterior forearm
b) hypesthesia/hypesthesia in ____ part of lateral 3 1/2 digits
Median nerve entrapment;
Symptoms:
a) pain and tenderness in the proximal anterior/posterior forearm
b) hypesthesia/hypesthesia in LATERAL part of lateral 3 1/2 digits
Damage to median nerve at wrist results in:
Paralysis of _____ muscles and radial _____
similar to hand of benediction BUT
RETAIN: flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus
LOSE: Abductor pollicis brevis, flexor pollicis brevis, opponens pollicis and lateral two lumbricals;
Damage to median nerve at wrist results in: ADDUCTED THUMB
Paralysis of THENAR muscles and radial LUMBRICALS
similar to hand of benediction BUT
RETAIN: flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus
LOSE: Abductor pollicis brevis, flexor pollicis brevis, opponens pollicis and lateral two lumbricals;
Damage to median nerve at the wrist is similar to hand of benediction BUT
there is a loss of _____ from digit 1, and WEAKENED digit 1 ____ and ______
Damage to median nerve at the wrist is similar to hand of benediction BUT
there is a loss of opposition from digit 1, and WEAKENED digit 1 flexion and abduction
Any condition that reduces the size of the tunnel in the hand and results in compression of the ___ nerve
Any condition that reduces the size of the tunnel in the hand and results in compression of the median nerve
Symptoms of carpal tunnel
sensory deficits
muscle weakness with associated musculature
Lateral epicondylitis also known as
tennis elbow
Medial epicondylitis also known as
golfer’s elbow
Disease of palmar fascia and aponeurosis, typically in > 50yr old caucasian men;
Dupuyten contracture
Dupuyten contracture causes shortening on the ____ end of hand resulting in ____ at the metacarpophalangeal and proximal PIP joints
Dupuyten contracture causes shortening on the medial end of hand resulting in flexion at the metacarpophalangeal and proximal PIP joints
Mallet finger: long ____ tendon avulsion
Presentation: ____ at the distal interphalangeal joint; inability to _____ DIP
Mallet finger: long EXTENSOR tendon avulsion
Presentation: flexion at the distal interphalangeal joint; inability to EXTEND DIP
Most commonly fractured carpal; Patient presents with pain and tenderness in anatomical ___ _____.
Common complication: _____ ______ - damage to the palmar carpal branch of the _____ artery
SCAPHOID
Most commonly fractured carpal; Patient presents with pain and tenderness in anatomical SNUFF BOX.
Common complication: AVASCULAR NECROSIS - damage to the palmar carpal branch of the RADIAL artery
Hamate fracture can compress the ___ nerve, leading to loss of sensation in the medial half of digit __ and the whole digit ___.
Hamate fracture can compress the ULNAR nerve, leading to loss of sensation in the medial half of digit 4 and the whole digit 5
Extension fracture of the distal radius;
Colles fracture
Flexion fracture of the distal radius (MUCH LESS COMMON)
Smith fracture
Radial nerve injury of the DEEP BRANCH ONLY:
results in no loss of sensation and inability to extend ___ and fingers at the ___ joint
Radial nerve injury of the DEEP BRANCH ONLY:
results in NO loss of sensation and inability to extend THUMB and fingers at the MCP joint
Radial nerve injury at humerus mid-shaft (radial groove) results in:
inability to extend wrist & fingers (metacarpophalangeal, PIP, DIP joints)
wrist remain partly _____ due to supposed flexor tone and gravity
Radial nerve injury at humerus mid-shaft (radial groove) results in:
inability to extend wrist & fingers (metacarpophalangeal, PIP, DIP joints)
wrist remain partly flexed due to supposed flexor tone and gravity
