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CP 1080 > UL Clinical anatomy > Flashcards

UL Clinical anatomy Flashcards

1
Q

What does INEWS stand for?

A

Irish National Early Warning Score

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2
Q

Vital signs on INEWS chart

A

ABCDE
Airway and Breathing (respiratory rate, peripheral oxygen saturation, supplemental oxygen)
Circulation (HR + BP)
Disability (consciousness)
Exposure (temperature)

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3
Q

What does dynamap measure?

A

Peripheral oxygen saturation, heart rate, blood pressure

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4
Q

Structure of patient history

A

Name and Age
Presenting complaint
History of complaint
Past med history
Medications
Allergies
Family history
Social/personal history
Review systems

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5
Q

SOCRATES? nature of pain

A

Site
Onset
Character
Radiation
Associated symptoms
Time (duration + periodicity)
Exacerbating factors
Severity

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6
Q

Nodal Osteoarthritis

A
  • Heberden’s nodes and lateral deviation of DIP joints, with mild Bouchard’s nodes at PIP joints

Eytan’s notes:
- DIP
- Joints most commonly affected (in order): DIP, first MCP, first MTP
- Hips and knees commonly affected
- Pain worsens as the day goes (usually worse at night)
- Usually non-symmetrical

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7
Q

Rheumatoid arthritis

A
  • Ulnar deviation of fingers & wasting of small muscles in hand & synovial swelling at wrist, extensor tendon sheaths, MCP joints and PIP joints

Eytan’s notes:
- MCP + PIP
- Multisystem (auto-immune): rashes, painful and dry red eyes, dry mouth, fatigue, ask for family history (celiac, diabetes)
- Early morning stiffness (>30 mins is significant)
- Usually symmetrical (same pain in both hands)

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8
Q

What does a fracture of the surgical neck of humerus damage?
What does it result in?

A

Axillary nerve damaged
Loss of deltoid action
Loss of abduction

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9
Q

Where is the site of intramuscular injection in the UL , and why?

A

Deltoid
Has no major blood vessels/nerves

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10
Q

Where is the median nerve in the ante cubital fossa?

A

Just medial to brachial artery

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11
Q

How is Allens test performed?

A

Elevate hand (venous drainage)
Occluded radial and ulnar artery
Close fist (venous drainage) , accentuates ischaemia produced by arterial occlusion
After 30s , open palm (diffuse pallor present)
Release ulnarartery
Hand go red indicating reperfusion

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12
Q

What are the boundaries of the anatomical snuff box?

A

Anterior : APL, EPB
Posterior : EPL

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13
Q

How is rupture of the flexor digitorum superficialis (FDS) and profundus (FDP) assessed?

A

Check to see if there function FDS to little finger:
- Using left hand to hold index, middle and ring fingers in extension (this inactivates the tendons of FDP to those fingers and to the little finger also - because of the connections between the tendons of FDP)
- Ask the student/ patient to flex little finger.
- Ability to flex the little finger at the PIPJ indicates a working FDS tendon to that finger.

To test FDP alone: hold the finger in extension at the PIPJ. Ability to flex the DIPJ indicates a functioning FDP

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14
Q

What can supracondylar fracture damage?

A

Can cause damage to the brachial artery which in turn can compromise blood supply to the muscles of the forearm leading to Volkmann’s Ischaemic Contracture

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15
Q

What muscles in the hand does the median nerve supply?

A

LOAF
Lumbrical I and II
OP (opponens pollicis)
APB (abductor pollicis brevis)
FPB (flexor pollicis brevis)

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16
Q

What’s the sensory innervation of median nerve in the hand?

A

Palmar digital nerves: skin on anterior aspect of lateral 3 and a half digits + skin on posterior aspects of nailbeds

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17
Q

What are the signs of damage to median nerve in carpal tunnnel

A
  • Simian hand (ape like), thumbs comes into plane of hand
  • Wasting thenar eminence
  • Weakness of opposition and abduction
  • Paralysis of lateral 2 lumbricals = impaired fine control movements of index and middle fingers
  • Loss of sensation of front and nail beds of 3rd to 5th fingers (lateral 3 and a half fingers)
  • Tapping on median nerve at flexor retinaculum = tingling sensation in the distribution of the nerve (Tinel’s sign)

(DR CUMA: Median nerve = Ape hand)

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18
Q

What is Froment’s Test and what is it testing for

A

Ulnar nerve damage
Hold paper between extended thumb and palm
Try pull paper away

(Paralysis of adductor pollicis = inability to adduct thumb —> Froment’s sign: patient holds paper between thumb and index, doctor pulls on it, patient will compensate for adductor by flexing flexor pollicis longus)

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19
Q

What is the most common shoulder dislocation
What position would patient hold arm in

A

Anteriorinferior

Arm held abducted , forearm flexed and supported

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20
Q

What is Allens test

A

Occlude ulnar and radial until hands blanch
Release ulnar to see if hand return to colour if radial were to be cannulated (thin tube put in)
Evaluates collateral circulation

21
Q

Importance of blood supply to scaphoid

A

Scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply.

22
Q

What is meant by
collateral circulation in hand?

A

The hand receives blood from two arteries – the radial and ulnar arteries
If one of these becomes damaged blood supply to the muscles of the hand and fingers (and skin) continues through the other artery

23
Q

What is arterial blood gas sampling & why is it important?

A

Blood is collected from the radial artery to measure the amount of oxygen (PO2) and other gases in it if the patient is having difficulty breathing.
It is important to check that there is good blood flow through the ulnar artery (collateral circulation) before doing a radial artery puncture to collect blood in case it is damaged during the procedure

24
Q

Claw Hand

A

Ulnar nerve damage
Ring and little fingers are seen to be hyperextended at the MCP and flexed at the interphalangeal joints.

(DR CUMA: Claw = Ulnar)

25
Q

Injury to medial epicondyle: nerve damaged + signs of injury

A

Ulnar nerve

Sensory loss:
- Numbness/tingling over palmar and dorsal aspects of medial 1 and a half digits, medial palm and dorsum of hand

Motor Loss:
- Paralysis of flexor carpi ulnaris = weakening of wrist flexion wrist + lateral deviation + wrist abduction is weak
- Paralysis of medial half of flexor digitorum profundus = inability to flex distal phalanges of little and ring fingers
- Paralysis of adductor pollicis = inability to adduct thumb —> Froment’s sign: patient holds paper between thumb and index, doctor pulls on it, patient will compensate for adductor by flexing flexor pollicis longus
- Paralysis of palmar and dorsal interossei = inability to abduct/adduct fingers —> unable to hold paper between thumb and index or between the other fingers —> muscle wasting —> hollowing between the metacarpal bones
- Paralysis of 2 medial lumbricals = ulnar claw (hyperextension of MP joints + flexion of IP joints on ring and little fingers)

26
Q

Saturday night palsy

A
  • Injury to radial nerve
  • Paralysis of extensor muscles of entire UL
  • Paralysis of muscles of posterior compartment of forearm = inability to extend the wrist and MP joints —> wristdrop (IP joints can still be extended since interossei and lumbricals are supplied by ulnar and median nerves) —> DR CUMA: Drop = Radial
  • Paralysis of triceps = inability to extend the elbow
  • Supination is impaired (can still be performed by the biceps) —> triceps can’t act as a synergist with biceps during supination —> supination can’t take place
    without associated flexion at the elbow (both actions of biceps)
  • Impaired sensation on dorsal aspect of arm, forearm, hand and proximal parts of the lateral 3 and a half digits
27
Q

Fracture of shaft of the humerus involving the spiral groove can result in injury to what?

A

Radial nerve

28
Q

Symptoms of arthritis

A
  • Pain
  • Mobility (loss of mobility)
  • Stiffness (+ swelling of joints, heat)

(mnemonic: PMS)

29
Q
A
  • Acromion process more popped out, contour is gone, humerus is lower and more medial
  • Dislocation of right shoulder
  • Supporting his right arm with left arm
30
Q
A

Head of humerus isn’t in glenoid cavity anymore

31
Q
A
  • Surgical neck of humerus (fracture)
  • Axillary nerve can be damaged –> problems with abduction (deltoid)
32
Q
  • Where is the brachial artery likely to be damaged?
  • Where are pulses in the upper limb palpable?
A
  • Likely to be damaged in the cubital fossa
  • Palpable at brachial, ulnar and radial arteries
33
Q

What structures can be damaged during venepuncture in cubital fossa?

A

Brachial artery and median nerve (deep to median cubital vein)

34
Q

Case: A 42-year-old woman working in a busy café attends her GP with discomfort in both her hands which has been going on for at least three months. She notices it particularly at night when she is trying to go to sleep and describes it as a tingling sensation in her thumb, index and middle finger. On examination there is loss of sensation over these fingers.
Questions:
1. Given the distribution of the sensory loss which nerve is likely to be affected?
2. You suspect that this patient has Carpal Tunnel Syndrome. What is CTS and why has this patient developed it? Please refer to the relevant underlying anatomy.
3. What might you inspect this patient’s hands if this condition was severe and long-standing?
4. Name one physiological and one pathological condition that predisposes this condition?

A
  1. Median nerve
  2. CTS = compression on carpal tunnel –> prolonged pressure on median nerve (overuse injury of flexor tendons by constantly holding a lot of weight –> tissues inflamed and swollen –> compress median nerve)
  3. LOAF muscles might be wasted –> test opposition and abduction strength
  4. Physiological = pregnancy ; pathological = rheumatoidarthritis!
35
Q

Examine this

A
  • Radial styloid process is on same plane as ulnar styloid process (radial should be more distal)
  • Fracture of radius –> Colle’s fracture
  • Also a posterior dislocation (dinner fork deformity)
36
Q

Where can brachial pulse be palpated?

A

Mid arm - against medial side of humerus
Cubital fossa: medial to biceps tendon

37
Q

Klumpke palsy

A
  • Injured C8-T1 (T1 usually torn, ± C8)
  • Small muscles of hand affected (T1 in ulnar and and median nerves —> claw hand deformity)
  • Loss of sensation across medial side of arm (T1)
  • ± loss of sensation on medial side of forearm, hand and medial 1 and a half fingers (C8)
38
Q

Which artery is most likely injured in supracondylar fracture of the humerus? What is the consequence for the patient?

A

Brachial artery
Ischaemia (lack of blood supply) of forearm muscles → ischaemic contracture (uncontrolled flexion of hand)

39
Q

Erb-Duchenne palsy

A
  • Waiters tip position
  • Injury to C5-6
  • UL hangs limply
  • UL medially rotated at shoulder due to unopposed action of pectoralis major
  • Elbow extended + forearm pronated due to loss of action of biceps + brachialis
  • Loss of sensation to lateral side of arm
40
Q

Where would you find the ulnar artery pulse

A

Lateral to tendon of flexor carpi ulnaris

41
Q

A patient falls from a bike and injures the upper trunk of the brachial plexus. What are the consequences for the patient? Explain.

A

Muscles supplied by C5 & C6 affected:
- UL hangs limply by the side (shoulder adducted),
- UL medially rotated at shoulder jt (unopposed action of pectoralis major)
- Elbow extended & Forearm pronated (loss of action of biceps & brachialis)
- Loss of sensation to lateral side of arm (C5, C6 dermatomes)
- Erb-Duchenne palsy/waiter tip position

42
Q

A builder fell from a ladder. As he fell, he clutched to the lower steps of the ladder which resulted in excessive abduction of his arm and he injures the lower trunk of the brachial plexus. What are the consequences for the patient? Explain.

A

Muscles supplied by C8 & T1 affected:
- All small muscles of the hand affected (T1 in ulnar and median nerves) → claw hand deformity
- Loss of sensation of: medial side of arm (T1 dermatome), medial side of forearm & hand & medial 11⁄2 fingers (C8 dermatome).
- Klumpke palsy

43
Q

Monteggia’s fracture

A

Result of a force from behind the ulna
Proximal ulna is fractured and the head of the radius dislocates anteriorly at the elbow.

Mnemonic:
- MUR = Monteggia, Ulna fracture (proximal), Radius dislocation (head)
- GRU = Galeazzi, Radial fracture (distal), Ulna dislocation (head)
To remember that Monteggia is proximal and Galeazzi is distal: My God = Monteaggi is before Galeazzi (MG)

44
Q

Galeazzi’s fracture

A

Fracture of distal radius
Head of ulna dislocates at distal radio-ulnar joint

45
Q

Colle’s fracture

A
  • Fracture + posterior dislocation of distal radius
  • Caused by falling onto outstretched hand
  • Ulnar styloid process is also often damaged
  • Normally, radial styloid process extends more distally than ulnar styloid process, but this is reversed in Colle’s fracture –> dinner fork deformity
46
Q

Normal values for respiratory rate (breaths per minute) and for oxygen saturation

A
  • RR: 12-20 breaths per minute
  • Saturation: ≥ 96%
47
Q

Normal values for heart rate (beats per minute)

A

Between 50 and 90 bpm

48
Q

Normal values for blood pressure (systolic)

A

Between 110 and 250 mmHg

49
Q

Normal values for temperature

A

Between 36 and 38 °C

CP 1080 (4 decks)

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