Unit 2 Clinic upper limb

Question 1

Fracture to the distal radius where the broken end bends backwards and puts the median nerve at risk of damage?

Answer 1

Colle’s fracture

Question 2

Distal fragment of radius is displaced posteriorly and overrides the rest of the bone to cause what?

Answer 2

dinner fork deformity

Question 3

Distal fragment of radius is displaced anteriorly and overrides the rest of the bone?

Answer 3

smith fracture

Question 4

Axillary artery can be damaged by what injuries?

Answer 4

A fracture of the humerus at the surgical neck, dislocation of shoulder, compression from improper use of crutches and intramuscular injections

Question 5

A transverse fracture of the humerus is caused by what and can damage what nerve?

Answer 5

direct blow, radial nerve which runs along radial groove of humerus

Question 6

A spiral fracture of the humerus is caused by what and can damage what nerve?

Answer 6

indirect from a fall on outstretched hand, radial nerve which runs along radial groove of humerus

Question 7

An intercondylar fracture is caused by what and can damage what nerve?

Answer 7

severe fall on flexed elbow, median or ulnar nerve may be damaged

Question 8

What is the weakest part of the clavicle that is prone to fracture?

Answer 8

junction between middle and lateral thirds

Question 9

What is the clinical sign of a broken clavicle and why does it occur?

Answer 9

shoulder drop because the sternocleidomastoid muscle holds up the medial portion of the clavicle but the trapezius is unable to hold up the later portion

Question 10

What prevents dislocation of the clavicle at the acromiclavicular joint after a fracture of the clavicle?

Answer 10

the coracoclavicular ligament

Question 11

What is the most common carpal fracture?

Answer 11

scaphoid at its most narrow part from a fall on plan when hand is abducted.

Question 12

Why is a fractured scaphoid slow to heal?

Answer 12

Proximal part of bone has poor blood supply so it is slow to heal. May cause avascular necrosis and degenerative joint disease

Question 13

Which of the rotator cuff muscles in most prone to injury and why?

Answer 13

supraspinatus because it is most avascular and prone to wear on the acromion

Question 14

What would be the effect of damage to the long thoracic nerve?

Answer 14

• winged scapula
• unable to abduction beyond 90 degrees due to limited rotation of glenoid cavity
• no sensory loss

Question 15

What is caused by damage to superior trunk of brachial plexus?

Answer 15

Erb-Duchenne palsy which causes paralysis to muscles of the shoulder and arm that are supplied by C5 and C6 and sensory loss to lateral antebrachium. Presents as “waiter’s tip position”.

Question 16

What is caused by damage to the inferior trunk of brachial plexus?

Answer 16

Klumpke palsy which causes paralysis of short muscles of the hand and sensory loss to medial hand. Presents with “claw hand”

Question 17

Repeated pressure and friction of the bursa in the elbow causes?

Answer 17

subcutaneous olecranon bursitis, “student’s elbow”

Question 18

Dislocation of the elbow can result in damage to what nerve?

Answer 18

ulnar n.

Question 19

Radial/humeral dislocation is also called what?

Answer 19

nursemaid’s elbow

Question 20

Wear and tear of the long head of the biceps causing inflammation as seen in sports with throwing or a racquet is called what?

Answer 20

biceps/bicipital tendinitis

Question 21

Ruptured tendon of the long head of the biceps brachii is called what?

Answer 21

popeye’s deformity

Question 22

What can cause damage to the musculocutaneous nerve?

Answer 22

It is rare but a knife wound could

Question 23

What would be affected by injury to the musculocutaneous nerve?

Answer 23

the functions of the biceps, brachialis, and coracobrachialis: elbow and shoulder flexion as well as supination. Lateral forearm would have sensory loss also

Question 24

Injury to radial nerve superior in arm would cause what?

Answer 24

paralysis of triceps brachii, brachioradialis, supinator and wrist/hand extensors
loss of sensation to inferior lateral arm, posterior arm, forearm, dorsal of hand and lateral fingers

Question 25

What are some causes of radial nerve injury?

Answer 25

• improper use of crutches
• “Saturday night palsy”
• posterior dislocation of the glenohumeral joint

Question 26

What is the characteristic disability with radial nerve injury?

Answer 26

wrist drop due to inability to extend wrist and fingers

Question 27

Injury to the radial nerve in the radial groove would cause what?

Answer 27

• weaken the triceps because only medial head would be affected
• paralysis of all other posterior forearm muscles
• loss of sensation to dorsal of hand and lateral fingers

Question 28

inflammation of common flexor tendon is called what?

Answer 28

Golfer’s elbow or medial epicondylitis

caused by activities requiring gripping

Question 29

Injury to median nerve at elbow results in what?

Answer 29

“hand of benediction” because 1st and 2nd lumbricals and thenar muscles are affected
-sensory loss to lateral 2/3 of palm and palmar side of radial 3 1/2 digits and tips

Question 30

Compression of the median nerve between the two head os pronator teres is called what?

Answer 30

pronator/nerve entrapment syndrome

-caused by repeated pronation activities

Question 31

Injury to ulnar nerve at elbow results in what?

Answer 31

“claw hand” due to unopposed action of extensor s of MP joint and flexor digitorum superficially at PIP joint
-sensroy loss to medial aspect of palm, dorsum of hand and medial 1.5 digits

Question 32

Pain associated with repetitive use of extensor forearm muscles?

Answer 32

tennis elbow or lateral epicondylitis caused by inflammation of the periosteum of lateral epicondyle

Question 33

Damage to the deep branch of the radial artery results in what?

Answer 33

inability to extend thumb and MP joints

-no sensory loss

Question 34

Damage to the superficial branch of the radial artery results in what?

Answer 34

Loss of sensation over a small area at the base of 1st and 2nd metacarpals (median nerve and ulnar nerve overlap most of the area innervated by superficial branch of radial nerve)

Question 35

Progressive shortening and thickening of palmar fascia and aponeurosis that occurs for unknown reasons and is more common in males over 50?

Answer 35

Dupuytren Contracture

Question 36

What is ulnar canal syndrome?

Answer 36

compression of the ulnar nerve in the tunnel of Guyon resulting in diminished sensation in the medial 1.5 digits and weakness in the intrinsic hand muscles

Question 37

Injury to ulnar nerve before ulnar canal results in what?

Answer 37

loss of motor function to PADs, DABs and hypothenars (add/abd digits and add thumb)
sensory loss to medial palm and medial 1.5 palmar digits

Question 38

What is carpal tunnel syndrome?

Answer 38

Any lesion that narrows the carpal tunnel causing compression of the median nerve. This alters sensation of lateral 3.5 digits, affects thumb coordination, thenar muscles can atrophy and pain can radiate into forearm and axilla

Question 39

What is Simian hand?

Answer 39

Wasting of the thenar muscles causing adduction and extension of the thumb. Can be seen in carpal tunnel syndrome

Question 40

Damage to the recurrent branch of the median nerve would result in what?

Answer 40

paralysis of the thenar muscles and loss of thumb function

Question 41

Injury to the median nerve, proximal to the flexor retinaculum would result in what?

Answer 41

Paralysis of the thenar muscles and 1-2 lumbricals

sensation loss over thumb and adjacent 2.5 digits