PBL 2

Question 1

what does elbow reduced mean

Answer 1

approached by either a prone or supine, prone approach is used first, it is when the long arm split is applied, flex the elbow at 90 degrees and place the forearm in a neutral position with respect to pronation and supination

Question 2

what is a triage nurse

Answer 2

this is a nurse that is the first point of contact for people in an emeregency department

Question 3

describe the elbow joint, what joints are there present in it and what ligaments does it form

Answer 3

• Made out of the humeroradial joint, the humeroulnar joint these both allow flexion and extneison
• The proximal radioulnar joint allows pronation and supination
• Carrying angle larger in women then in men
• There is a radial collateral ligament and an ulnar collateral ligament
• As well as an anular ligament this goes around the head of the radius, this is what can become dislocated if there is a wide angle between the shoulder and rest of the body when children are being lifted up by there hands
• Anular ligament creates the proximal radioulnar joint and this permits pronation and supination of the forearm

Question 4

what causes flexion of the forearm

Answer 4

• Biceps brachii

- Brachilais

Question 5

what causes extension of the forearm

Answer 5

• Triceps brachii

Question 6

what causes pronation of the forearm

Answer 6

• Pronator teres

- Protantor quadratus

Question 7

what causes supination of the forearm

Answer 7

• Biceps brachii

- Supinator

Question 8

what innervates the posterior compartment

Answer 8

radial nerve

Question 9

what innervates the anterior compartment

Answer 9

musculocutaneous nerve

Question 10

what makes up the cubital fossa

Answer 10

• brachioradialis
• bicipital aponeurosis
• pronator teres

Question 11

what is the content of the cubital fossa

Answer 11

• Biceps brachii tendon
• Terminal part of the brachial artery
• Deep veins – brachial deep veins
• Median nerve

Question 12

what are the superficial flexors

Answer 12

– Pronator teres, - pronates
– Flexor carpi radialis
– Palmaris longus
– Flexor carpi ulnaris

Question 13

what do the superficial flexors act on

Answer 13

the wrist

Question 14

what are muscles that close the hand

Answer 14

• Flexor digitorum superficialis - flexes MCP and PIP
• Flexor digitorum profundus – flexes MCP PIP DIP
• Flexor pollicis longus – MCP and IP of thumb

Question 15

what are the muscles that open the hand

Answer 15

•	Extensor digitorum communis, 
–	4 tendons
•	Extensor indicis
–	 index finger
•	Extensor digiti minimi 
–	little finger

Question 16

what are the intrinsic muscles of the hand

Answer 16

• thenar – act of the thumb
• hypothenar – act on the little finger
• Lumbricals, flex MCP extend interphalangeal joints of 2nd-5th digits
• Dorsal interossei, abduct 2nd-4th digits. Assist lumbricals
• Palmar interossei, adduct 2nd,4th and 5th digits, assist lumbricals

Question 17

what is the sensory supply for the median nerve

Answer 17

palm of the hand - thumb to. half of ring fingeringer

- back of the hand tips of the thumb, to half of ring finger

Question 18

what is the sensory supply for ulnar nerve

Answer 18

half of ring finger to little finger for both palm and back of hand

Question 19

what is the sensory supply for radial nerve

Answer 19

back of hand until ring finger half

Question 20

what are the sensory tests for the hand

Answer 20

radial - first inter web
median - lateral half of index finger
ulnar - medial half of little finger

Question 21

what happens when you have radial nerve damage

Answer 21

• Gives wrist drop
• No extensors as they are in the posterior part of the arm where the radial nerve innervates
• Depends on where injury takes place – mid shaft radial innervation to long head of triceps has already come off already so only lateral and medial heads of triceps is lost therefore you have weak elbow extensions

Question 22

what happens when you have high median nerve damage

Answer 22

• Hands of benedicition
• Supracondylar fractures of the humerus
  o Hand of benediction
• When patient asked to make a fist (classic)
  o Loss of flexion of MCP digits 2-3
  o Loss of flexion of PIP in digits 1-3
  o Loss of DIP flexion digits 2-3
  o Weak PIP flexion of digits 4-5
  o Can flex DIP of digits 4-5
   Because ulnar nerve innervates medial FDP and FCU

Question 23

what happens when you have low median nerve damage

Answer 23

• Carpal tunnel syndrome:
• Any condition reducing size of carpal tunnel causes compression of median nerve
• Progressive loss of co-ordination and strength in thumb

Question 24

what happens if you have ulnar nerve damage

Answer 24

• Claw hand
• Muscles paralyzed are:
• flexor carpi ulnaris,
• medial half of FDP,
• medial two lumbricals,
• all interossei (palmar and dorsal)
• adductor pollicis