UE: Forearm, Wrist, Arm, Neuro correlates Flashcards by Denisse Tiangco

Structures damaged in elbow dislocation

Ulnar nerve
Median nerve
Brachial artery

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Main stabilizer of superior radioulnar joint

Annular ligament

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Pivot joint of radius and ulna

Superior radioulnar joint

Inferior radioulnar joint

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Transmits force from radius to ulna

Interosseous membrane

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Nursemaid’s elbow
Pulled elbow
Associated with annular ligament tear

Radial head dislocation

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Monteggia fracture

Ulnar fracture
Superior dislocation

GRIMUS

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Galleazi fracture

Radial fracture
Inferior dislocation

GRIMUS

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Dorsal or posterior displacement of DISTAL fragment

Dinner fork deformity

FOOSH

Colles fracture

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Volar/anterior displacement of the DISTAL fragment

Smith fracture

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Interarticular fracture of distal radius

Dislocation of radiocarpal joint

Barton fracture

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Two rows, four each

Carpal bones

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Proximal row (L hand) anatomic position
Lateral to medial

Scaphoid
Lunate
Triquetrium
Pisiform

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Distal row (L hand) anatomic position
Lateral to medial

Trapezium
Trapezoid
Capitate
Hamate

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Sesamoid bone of carpals

Pisiform under FCU tendon

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Forms saddle joint with first MCP

Trapezium

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sesamoid bone in ear

lenticular process of incus

fourth ossicle

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Thenar muscles of hand

Adductor pollicis
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Median nerve

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Hypothenar muscles of hands

Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi
Palmaris brevis
Ulnar nerve

OAFP

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Interossei muscles of hand

PAD (3) Palmar interossei Adducts

DAB (4) Dorsal interossei Abducts

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Lumbricals of hands

Action

L1 and L2 by median nerve
L3 and L4 by ulnar nerve

Flex MCP and extend IP

Origin: FDP

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1st CMC joint is

saddle joint

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Swan neck deformity

HyperEXT of PIP

FLEX of DIP

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Boutonniere’s deformity

FLEX of PIP

Extension of DIP

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Most commonly fractured carpal bone

Scaphoid

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Avascular necrosis of scaphoid occurs in

proximal segment

Most commonly dislocated carpal bone

Lunate

Anterior dislocation of lunate leads to compression of the

Median nerve

Fracture of 5th MCP | Unskilled fighters

Boxer’s fracture

Most common type of metacarpal fracture

Boxer’s fracture

Fracture of base of the 1st metacarpal Instability of the

Bennet fracture CMC joint from forced ABDuction

Boundaries of anatomic snuffbox

Lateral MOST: APL Medial: EPB Medial MOST: EPL Floor: scaphoid and trapezium

Content of snuff box

radial artery

Boundaries of carpal tunnel

``` Flexor retinaculum (transverse carpal ligament) Carpal bones ```

Contents of carpal tunnel

``` 9+1 9 tendons: (4) FDS (4) FDP FPL ``` MEDIAN NERVE

Most common entrapment neuropathy

CTS

Has its own synovial sheath

FPL (radial bursa)

Common flexor tendon sheath

Ulnar bursa

Inserts on the lateral side of base of middle phalanx

FDS

Inserts on lateral side of distal phalanx

FDP

Long extensor tendons

Extensor digitorum

Extensor tendon rupture over DIP most usually from basketball

Mallet finger

Mallet finger:

DIP Flexion

Pain in compartment 1 of APL and EPB Special test:

DeQuervain’s Finkelstein test

Middle of middle phalanx to distal palmar crease

No man’s land | Zone II

Muscles affected in Zone 2

FDS | FDP

Skier’s thumb | Injury to ulnar collateral ligament of thumb

Gamekeeper’s thumb

Dorsal scapular nerve supply the muscles

Rhomboid major Rhomboid minor Levator scapulae

Suprascapular nerve serves

Supraspinatus | Infraspinatus

Lateral pectoral nerve supplies

Pectoralis major

Medial pectoral nerve serves the

Pectoralis major | Pectoralis minor

Subscapularis is innervated by

Upper subscapular | Lower subscapular

Lower subscapularis supplies the

Teres major | Subscapularis

Latissimus dorsi innervation

Thoracodorsal nerve | Middle subscapular nerve

Patient unable to use axillary crutches | Severed in mastectomy

Thoracodorsal nerve injury

Flexion and abduction of shoulder

Pectoralis major | Deltoid

Adduction of shoulder

Pectoralis major | Lattisimus dorsi

Shoulder extension

Latissimus dorsi

Shoulder External Rotation

Infraspinatus | Teres minor

Shoulder internal rotation

Subscapularis

Elbow flexion

Brachialis

Elbow extension

Triceps brachii medial head

Supinates forearm

``` Biceps brachii (forceful) Supinator (unopposed) ```

Pronates forearm

Pronator quadratus

Brachial plexus parts

``` Root Trunk Division Cords Branch ```

Related to axillary artery in brachial plexus

Cords

Upper trunk injury More common From forceful pulling of head during delivery Downward displacement of arm

Erb Duchenne Palsy C5-C6 Waiter’s tip without moro or startle reflex

Inferior dislocation of shoulder or fracture of surgical neck of humerus Damage to quadrangular space Loss of sensation over lower half of deltoid Leads to deltoid and teres minor atrophy

Axillary nerve C5-C6 injury

Lower trunk injury Forced abduction of arm Sx:

Klumpke paralysis C8-T1 Sx: Claw hand and ape deformity With or without Horner’s (T1)

Damage to serratus anterior leads to medial winging of scapula

Long thoracic nerve | C5, C6, C7

Neck surgery leading to dropped shoulder might have damaged

Spinal accessory nerve | Trapezius paralysis

Musculocutaneous neuropathy Motor: Sensory:

Forearm flexion Supination Lateral forearm

Surgical neck fracture of the humerus Dislocation of humeral head Pressure from badly adjusted axillary crutch

Axillary neuropathy

Axillary neuropathy deficits Motor: Sensory:

Shoulder abduction Shoulder external rotation Regimental patch area

Ill fitted crutches

Radial nerve

Between tendinous arch of humeral and ulnar heads of the FCU

Cubital tunnel

Converted into fibro-osseous tunnel by pisohamate ligament

Ulnar canal | Tunnel of Guyon

Guyon’s canal boundaries

Roof: palmar carpal ligament blending into FCU attaching to pisiform and pisohamate ligament Medial: pisiform and pisohamate ligament Lateral: hook of hamate, some fibers of transverse carpal ligament Ulnar nerve enters Guyon accompanied by Ulnar artey and vein Guyon’s canal lies in space between flexor retinaculum and volar carpal ligaments

Fracture of medial epicondyle Cubital tunnel syndrome Fracture of hook of hamate

Ulnar neuropathy

Musculoaponeurotic canal that represents important site of ulnar nerve entrapment

Arcade of struthers

Patient grips piece of paper between thumb and index finger Flexion of IP joint of thumb + ulnar nerve paralysis

Froment sign

``` Supracondylar fracture Carpal tunnel syndrome Pronator teres syndrome Anterior interosseous syndrome Ligament of struthers ```

Median neuropathy

Median neuropathy at the elbow deficits: Motor: Sensory:

Weak wrist flexion Pronation Papal benediction sign Ape like hand Lateral 1/2 of palm Palmar aspect of lateral 3 and 1/2 of finger Eye of hand

Median neuropathy AIN syndrome Damage to AIN is purely

Motor Deep muscles of anterior compartment FPL FDP, lateral 1/2 Pronator quadratus Patient unable to make ok sign

Saturday night palsy Honeymooner’s palsy Crutch palsy Humeral midshaft fracture of spiral groove Fractures and dislocation of proximal humerus PIN syndrome

Radial neuropathy

Entrapment of superficial branch of radial nerve, numbness, tingingling and weakness of posterior aspect of thumb

Wartenburg syndrome

Radial neuropathy deficits Motor: Sensory:

Loss of forearm extension Supination Wrist drop Finger drop Posterolateral arm Posterior forearm Lateral part of the dorsum of the hand Dorsal surface of the lateral 3 and 1/2 fingers

Radial neuropathy Continuation of the deep branch of the radial nerve Purely

Posterior interosseous nerve Motor

Posterior interosseous nerve deficits Motor: Sensory:

Weak wrist and finger extension Unopposed radial deviation NO WRIST DROP

Supinator syndrome at arcade of froshe | Radial tunnel syndrome at lateral intermuscular septum

Posterior interosseous nerve syndrome

Thumb dermatome

Middle finger dermatome

Little and ring finger dermatome

Nipple dermatome

Epigastrium/xiphoid dermatome

Umbilicus dermatome

T10

Groin dermatome

Great toe dermatome

Dorsum of foot dermatome

Little toe dermatome

Perianal dermatome

All muscles of the hands are innervated by ulnar nerve except

FCU FDP Median half which are innervated by the median nerve

Separates anterior and posterior compartment of the arm

Lateral and medial intermuscular septum continuous with deep fascia of arm

Muscles of anterior compartment of arm

Biceps brachii Coracobrachialis Brachialis

Short head of biceps brachii originates from Long head originates from and inserts to the Blood supply

Coracoid process of scapula Supraglenoid tubercle Radial tuberosity

Brachialis originates from and inserts to the Blood supply

Anterior surface of distal half of humerus ulnar tuberosity

Posterior compartment of arm muscles

Triceps brachii Long Medial Lateral

Triceps originates from and inserts to the Blood supply

Infraglenoid tubercle (long head) Olecranon process Adducts arm (long head) Deep brachial Posterior circumflex humeral (long)

Superficial layer of the anterior forearm

Palmaris longus FCU FCR Pronator teres

Intermediate layer of anterior forearm

FDS Flexes MCP and PIP Splits to give way to passage of FDP

Deep layer of anterior forearm

FDP (Flexes DIP) FPL (Flexes thumb at IP) Pronator quadratus

Superficial layer of posterior compartment of forearm (7)

``` Brachioradialis (supracondylar ridge -> distal radius) accessory elbow flexor ECRL ECRB Extensor Digitorum Extensor Digiti Minimi Extensor Carpi Ulnaris Anconeus ```

Deep muscles of the posterior forearm

``` Supinator APL EPB (Ext MCP and CMC of thumb) EPL (Ext IP of thumb and CMC of thumb) Extensor indicis (extends index) ```

Fibrous band of CT arching over carpal band

Flexor retinaculum

Space between carpal tunnel and flexor retinaculum

Carpal tunnel 9 + 1

Intrinsic muscles of hand (6)

``` Thenar Hypothenar Palmaris brevis Lumbricals Interossei Adductor pollicis ```

Thenar muscles

Opponens pollicis (deepest) Abductor pollicis brevis Flexor pollicis brevis Origin: flexor retinaculum inserting to thumb

MEAT LOAF

Median nerve Lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis

Hypothenar muscles

Opponens digiti minimi Abductor digiti minimi Flexor digiti minimi brevis Origin: pisiform innervation: deep branch of ulnar nerve

Adducts thumb

Adductor pollicis

Deep palmar branch of ulnar artery anastomoses with

Radial artery to form deep palmar arch

Ulnar artery terminates by forming

Superficial palmar arch

Superficial palmar arch is formed by union of

Ulnar artery and superficial palmar branch of radial artery

Blood supply of thumb

Princeps pollicis

Blood supply of index

Radialis indicis artery

FOOSH deep tenderness in anatomic snuffbox Damages radial artery with subsequent avascular necrosis of the bone

Fracture of scaphoid

Injures ulnar nerve and artery because they are near

Hamate fracture (near the hook)

Guyon’s canal is formed by

Pisiform Hook of hamate Pisohamate ligament Deep to palmaris brevis and palmar carpal ligament transmitting ulnar nerve and artery

Rupture of coracoclavicular ligament

Dislocation of acromioclavicular joint

Most common dislocation or subluxation direction of Shoulder joint

Anteroinferior

Referred pain to shoulder indicates involvement of

Phrenic nerve or diaphragm Supraclavicular nerve supplying sensory fibers over shoulder C3,C4 is closely related to phrenic C3-C5

Lateral cutaneous branch of 2nd intercostal nerve emerging from second intercostal space and communicates with medial brachial cutaneous nerve

Intercostobrachial T12

Vein vulnerable to being punctured during IV Superficial to bicipital aponeurosis Conmects basilic vein to cephalic vein over the cubital fossa

Median cubital vein

Proximal part of nailbed produces hard keratin and responsible for nail growth

Matrix

Narrow band of epidermis prolonged from proximal nail fold onto the nail

Eponychium

Distal to eponychium

Lunula or half-moon

Thickened epidermis deep to the distal end of nail

Hyponychium

Congenital absence of a limb

Amelia

Partial absence of a limb where hands are

Meromelia

Structures superficial to the flexor retinaculum

Ulnar nerve Ulnar artery Palmaris longus Palmar cutaneous branch of median nerve