Robertson Putting It All Together

Question 1

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

Answer 1

C5,6 Palsy

Question 2

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

Answer 2

C5,6,7

Question 3

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?

Answer 3

C8T1

Question 4

What happens when you get a preganglionic lesion?

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

because you screwed up your phrenic nerve

Question 7

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

Answer 7

because you damage the long thoracic nerve

Question 8

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

Answer 8

because you lose the dorsal scapular nerve

Question 9

How do you treat a spinal avulsion?

Answer 9

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

Question 10

What will you get if you have radial nerve palsy?

Answer 10

you will get wrist drop

Question 11

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

Answer 11

the deep radial nerve

Question 12

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

Answer 12

your brachioradialis will begin to function

Question 13

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

Answer 13

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

Question 14

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

Answer 14

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

Question 15

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

Answer 15

three months

Question 16

What does palsy mean?

Answer 16

paralysis

Question 17

What does ulnar nerve damage cause key pinch?

Answer 17

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

Question 18

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

AND why does this happen

Answer 18

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

Question 19

What is fromonts sign?

Answer 19

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

Question 20

(blank) nerve is necessary for power grip

Answer 20

ulnar

Question 21

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

Answer 21

ulnar nerve damage

Question 22

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

Answer 22

the lumbricals

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

Question 23

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

Answer 23

lumbricals

Question 24

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

Answer 24

the abductor digiti minimi

Question 25

How do you differentiate ulnar nerve lesion at guyons vs elbow?

Answer 25

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.

Question 26

Where can you get ulnar nerve entrapment?

Answer 26

``` any level at root (C8-T1) Plexus (cervical rib, pancoast tumor) Cubital tunnel (elbow) Guyons canal (wrist) ```

Question 27

``` What are these borders for: Arcade of Struthers Intermuscular septum Medial head Tricep Anconeus Epitrochlearis Osborns Ligament Flexor Carpi Ulnaris ```

Answer 27

Cubital tunnel

Question 28

What is the roof of the cubital tunnel?

Answer 28

osborns ligament

Question 29

What kind of innervation does the ulnar nerve give you prior to bifurcation (i,e zone 1 of guyons canal)?

Answer 29

mixed motor and sensory

Question 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?

Answer 30

motor | sensory

Question 31

Where has the ulnar nerve been entrapped if these are the symptoms: Dorsal sensory intact Isolated intrinsic weakness

Answer 31

Wrist

Question 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

Answer 32

elbow

Question 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?

Answer 33

you do a sub muscular ulnar nerve transposition to bury it

Question 34

What will your hand look like if you lost your anterior interosseus nerve (branch of median nerve)?

Answer 34

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

Question 35

What nerve enters through the superficial and deep heads of the pronator teres?

Answer 35

median nerve

Question 36

What is the most commonly diagnosed entrapment in the upper extremity?

Answer 36

carpal tunnel syndrome

Question 37

What disorder is this: | Paresthesias and numbness aching pain in median nerve distribution, nocturnal symptoms, worse with use, thenar wasting

Answer 37

carpal tunnel syndrome

Question 38

Why can you still use your thumb even if you have median nerve damage?

Answer 38

because your adductor policis will work via the ulnar nerve | and your abductor pollicis longus will work due to your radial nerve

Question 39

What is the content of the carpal canal (tunnel)?

Answer 39

four tendons from FDP four tendons from FDS 1 tendon from flexor pollicis longus and the median nerve

Question 40

What is the content of guyon's canal?

Answer 40

ulnar nerve and artery

Question 41

How do you treat carpal tunnel?

Answer 41

cut the flexor retinaculum (carpal tunnel release) steroid injection bracing

Question 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

Answer 42

trigger finger

Question 43

Is carpal tunnel more biological or environmental?

Answer 43

biological

Question 44

When you have rubbing of the FDP tendon against the A1 tendon sheath, what do you get?

Answer 44

trigger finger

Question 45

Where is the AI tendon sheath?

Answer 45

at the MP joint

Question 46

What is the purpose of the pulley system (A1, A2 etc.)?

Answer 46

to keep the tendon tight against (opposed) to bone and maximize joint motion for given tendon movement (excursion)

Question 47

What is the relationship of FDP/FDS proximal to A1 vs. distal to A2?

Answer 47

FDS is superifical to FDP proximal to A1, but then splits and dives deep before coming back together at P1 (campers chiasma)

Question 48

What is campers chiasma?

Answer 48

The point where the tendons of the FDS splits and the tendons of flexor digitorum profundus pass between the split.

Question 49

What are the critical pulleys?

Answer 49

A2 and A4 (pulleys between MP and pip AND pip and dip) | *****primarily A2*****

Question 50

What happens if you release (mess up) your A2 and A4 pulley?

Answer 50

you get bowstringing of the tendon

Question 51

How do you often get pulley deficiency?

Answer 51

forced hyperextension

Question 52

What happens when you have an avulsion of your lateral band (i.e terminal tendon avulsion)?

Answer 52

mallet finger

Question 53

Describe the extension of the PIP and the DIP in a swan neck deformity?

Answer 53

hyperextension at the PIP (like huge amounts) and underextension at the DIP ***looks like swan neck****

Question 54

What are causes of swan neck?

Answer 54

``` terminal tendon attenuation (thinning) volar (palm) plate attenuation loss of FDS intrinisc tightness lateral band tightness dorsal skin tightness ```

Question 55

The (blank) can be defined as a very thick ligament that prevents hyperextension from occurring.

Answer 55

Volar Plate

Question 56

What does this cause: | an imbalance of power at the DIP causing flexion and an imbalance of power at the PIP causing extension?

Answer 56

swan neck

Question 57

What does this cause: | Increased extension of the DIP and increased flexion at the PIP

Answer 57

Boutonniere

Question 58

What is causes a boutonniere deformity?

Answer 58

central slip disruption | volar migration of lateral bands

Question 59

The midpalmar and thenar space are (blank) spaces.

Answer 59

potential space

Question 60

How many different spaces in the hand can you get compartment syndrome in? Name them

Answer 60

``` 10 each interossei has their own =7 adductor pollicis hypothenar thenar ```

Question 61

What is the terrible triad?

Answer 61

radial head fracture coronoid fracture elbow dislocation

Question 62

How do you get elbow dislocation?

Answer 62

lateral ulnar collateral disruption | medial ulnar collateral disruption

Question 63

What two things make up elbow stability?

Answer 63

osseous factors and soft tissue factors

Question 64

What are the 2 osseous components that make the elbow stable?

Answer 64

the coronoid process which prevents posterior and posterior medial displacement the radial head which prevents varus movement (adduction of your forearm)

Question 65

What are the 2 soft tissue components of the elbow that makes it stable?

Answer 65

lateral ulnar collateral (prevents varus, addcution of your forearm) the medial collateral (prevents abduction of your forearm/ valgus)

Question 66

What do the rotator cuff muscles do?

Answer 66

maintain glenohumeral relationship

Question 67

What goes in the suprascapular notch?

Answer 67

suprascapular artery

Question 68

What goes through the spinoglenoid notch?

Answer 68

the suprascapular artery and nerve

Question 69

What goes through the quadrilateral space?

Answer 69

posterior humeral circumflex artery and axillary nerve