Robertson Putting It All Together Flashcards

1
Q

If you have absence of shoulder abduction and external rotation, and elbow flexion what part of your brachial plexus is damaged?

A

C5,6 Palsy

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2
Q

If you have lack of wrist and finger extension what part of your brachial plexus is damaged?

A

C5,6,7

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3
Q

If you have a traction mechanism (ie. stretch injury) with intrinsic wasting of the muscles innervated by the ulnar nerve, what part of the brachial plexus i affected?

A

C8T1

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4
Q

What happens when you get a preganglionic lesion?

A

you get a spinal avulsion and therefore Horners, elevated hemi diaphragm, winged scapula, absence of rhomboid

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5
Q

So why do you get Horners when you have a spinal avulsion (preganglionic lesion)?

A

because you screwed up the sympathetic chain (due to ripping out T1)

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6
Q

Why do you get an elevated hemi-diaphragm when you have a spinal avulsion?

A

because you screwed up your phrenic nerve

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7
Q

Why do you get a winged scapula when you have a spinal avulsion?

A

because you damage the long thoracic nerve

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8
Q

Why do you get absence of motor function of rhomboids when you have a spinal avulsion?

A

because you lose the dorsal scapular nerve

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9
Q

How do you treat a spinal avulsion?

A

the nerve will not recover or regenerate so therefore you will have to have a nerve/tendon transfer

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10
Q

What will you get if you have radial nerve palsy?

A

you will get wrist drop

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11
Q

What is another name for the posterior interossesus nerve (PIN)?

A

the deep radial nerve

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12
Q

If you have a damaged radial nerve at the elbow, and it is undergoing recovery, what is the first sign that this is occuring?

A

your brachioradialis will begin to function

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13
Q

Where does the anterior interosseus come from and what does it do?

A

it comes off the median nerve and innervates deep forearm muscles (pronator quadratus, flexor digitorum profundus, flexor pollicis longus)

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14
Q

How do you get saturday night palsy and what is it?

A

when you arm is extended on the table and you sleep on it which makes you compress the radial nerve and you get wrist drop

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15
Q

How long does it take to improve your radial nerve compression injury from saturday night palsy?

A

three months

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16
Q

What does palsy mean?

A

paralysis

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17
Q

What does ulnar nerve damage cause key pinch?

A

cuz you lose adductor pollicis!!!!!!!!!!!

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18
Q
What am I describing:
MP hyperextension
lack of finger abduction/adduction
weak grip
lack of key pinch 

AND why does this happen

A

Ulnar damage
you get ulnar claw hand deformity which happens cuz you lose all interosseus and you lose you medial two head of your flexor digitorum profundus and the last two lumbricals. You get key pinch cuz you cant adduct thumb so you flex it hard to compensate And you lose flexor carpi ulnaris

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19
Q

What is fromonts sign?

A

when people use hyperflexion of their thumb to compensate for loss of adductor pollicis due to ulnar nerve damage

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20
Q

(blank) nerve is necessary for power grip

A

ulnar

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21
Q
What do these indicate:
Intrinsic wasting
Loss of palmer arch
Fromont’s Sign
Wartenberg’s Sign
Bouvier’s Maneuver
A

ulnar nerve damage

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22
Q

What muscle originates on a finger flexor and inserts onto a finger extensor?

A

the lumbricals

come from flexor digitorum profundus and attach to lateral band of extensor hood

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23
Q

What does this:
Passes palmer to axis of rotation of MCP
Dorsal to axis of PIP
Origin and insertion into tendon

A

lumbricals

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24
Q

In messed up ulnar injury, what muscle gets the most messed up?

A

the abductor digiti minimi

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25
How do you differentiate ulnar nerve lesion at guyons vs elbow?
if you damage it at elbow, you wont have cutanous innervation on the dorsal side of your wrist near the pinky, but if you have it, then it is nerve damage at the wrist.
26
Where can you get ulnar nerve entrapment?
``` any level at root (C8-T1) Plexus (cervical rib, pancoast tumor) Cubital tunnel (elbow) Guyons canal (wrist) ```
27
``` What are these borders for: Arcade of Struthers Intermuscular septum Medial head Tricep Anconeus Epitrochlearis Osborns Ligament Flexor Carpi Ulnaris ```
Cubital tunnel
28
What is the roof of the cubital tunnel?
osborns ligament
29
What kind of innervation does the ulnar nerve give you prior to bifurcation (i,e zone 1 of guyons canal)?
mixed motor and sensory
30
Distal to the bifuracation at guyons canal, the ulnar nerve splits to become deep and superficial. What does the deep branch of the ulnar nerve provide? What does the superficial branch of the ulnar nerve providee?
motor | sensory
31
Where has the ulnar nerve been entrapped if these are the symptoms: Dorsal sensory intact Isolated intrinsic weakness
Wrist
32
Where has the ulnar nerve been entrapped if these are the symptoms: Dorsal Sensory out Weakness in Ulnar Flexors +Intrinsics Elbow flexion reproduces symptoms
elbow
33
What do you do if you have an ulnar nerve that is getting displaced over your condyles due to contraction of a particular muscle?
you do a sub muscular ulnar nerve transposition to bury it
34
What will your hand look like if you lost your anterior interosseus nerve (branch of median nerve)?
When making the okay sign with your hand, you will flex your index finger to your thumb rather than abduct your thumb due to loss of thenar compartment muscles
35
What nerve enters through the superficial and deep heads of the pronator teres?
median nerve
36
What is the most commonly diagnosed entrapment in the upper extremity?
carpal tunnel syndrome
37
What disorder is this: | Paresthesias and numbness aching pain in median nerve distribution, nocturnal symptoms, worse with use, thenar wasting
carpal tunnel syndrome
38
Why can you still use your thumb even if you have median nerve damage?
because your adductor policis will work via the ulnar nerve | and your abductor pollicis longus will work due to your radial nerve
39
What is the content of the carpal canal (tunnel)?
four tendons from FDP four tendons from FDS 1 tendon from flexor pollicis longus and the median nerve
40
What is the content of guyon's canal?
ulnar nerve and artery
41
How do you treat carpal tunnel?
cut the flexor retinaculum (carpal tunnel release) steroid injection bracing
42
What is this: painful catching locking with finger range of motion. This is worse in the AM. You get symptoms in the PIP and catching at the MP
trigger finger
43
Is carpal tunnel more biological or environmental?
biological
44
When you have rubbing of the FDP tendon against the A1 tendon sheath, what do you get?
trigger finger
45
Where is the AI tendon sheath?
at the MP joint
46
What is the purpose of the pulley system (A1, A2 etc.)?
to keep the tendon tight against (opposed) to bone and maximize joint motion for given tendon movement (excursion)
47
What is the relationship of FDP/FDS proximal to A1 vs. distal to A2?
FDS is superifical to FDP proximal to A1, but then splits and dives deep before coming back together at P1 (campers chiasma)
48
What is campers chiasma?
The point where the tendons of the FDS splits and the tendons of flexor digitorum profundus pass between the split.
49
What are the critical pulleys?
A2 and A4 (pulleys between MP and pip AND pip and dip) | *****primarily A2*****
50
What happens if you release (mess up) your A2 and A4 pulley?
you get bowstringing of the tendon
51
How do you often get pulley deficiency?
forced hyperextension
52
What happens when you have an avulsion of your lateral band (i.e terminal tendon avulsion)?
mallet finger
53
Describe the extension of the PIP and the DIP in a swan neck deformity?
hyperextension at the PIP (like huge amounts) and underextension at the DIP ***looks like swan neck****
54
What are causes of swan neck?
``` terminal tendon attenuation (thinning) volar (palm) plate attenuation loss of FDS intrinisc tightness lateral band tightness dorsal skin tightness ```
55
The (blank) can be defined as a very thick ligament that prevents hyperextension from occurring.
Volar Plate
56
What does this cause: | an imbalance of power at the DIP causing flexion and an imbalance of power at the PIP causing extension?
swan neck
57
What does this cause: | Increased extension of the DIP and increased flexion at the PIP
Boutonniere
58
What is causes a boutonniere deformity?
central slip disruption | volar migration of lateral bands
59
The midpalmar and thenar space are (blank) spaces.
potential space
60
How many different spaces in the hand can you get compartment syndrome in? Name them
``` 10 each interossei has their own =7 adductor pollicis hypothenar thenar ```
61
What is the terrible triad?
radial head fracture coronoid fracture elbow dislocation
62
How do you get elbow dislocation?
lateral ulnar collateral disruption | medial ulnar collateral disruption
63
What two things make up elbow stability?
osseous factors and soft tissue factors
64
What are the 2 osseous components that make the elbow stable?
the coronoid process which prevents posterior and posterior medial displacement the radial head which prevents varus movement (adduction of your forearm)
65
What are the 2 soft tissue components of the elbow that makes it stable?
lateral ulnar collateral (prevents varus, addcution of your forearm) the medial collateral (prevents abduction of your forearm/ valgus)
66
What do the rotator cuff muscles do?
maintain glenohumeral relationship
67
What goes in the suprascapular notch?
suprascapular artery
68
What goes through the spinoglenoid notch?
the suprascapular artery and nerve
69
What goes through the quadrilateral space?
posterior humeral circumflex artery and axillary nerve