Upper Extremities Flashcards
Subluxation of the radial head out of the annular ligament in the proximal radio-ulnar joint. Clinically presents with children who are unable to supinate after injury.
Nursemaid’s Elbow / Pulled up Elbow
Caused by chronic inflammation or irritation of the origin of the extensor muscles of the forearm from the lateral epicondyle of the humerus as a result of repetitive strain. Common in tennis players / violinists.
Tennis Elbow / Lateral Epicondylitis
Caused by a tear or chronic inflammation in the origin of the flexor muscles of the forearm from the medial epicondyle. Treatment is IV glucocorticoids i the affected area or avoidance of repetitive bending / flexion of the forearm in order to not compress the ulnar nerve.
Golfer’s Elbow / Medial epicondylitis
Cyclists falling in their shoulder. Where’s the fracture?
Greater tuberosity of Humerus
Attachments
-supraspinatus
-infraspinatus
-teres minor
Common scenario: Accompanies posterior dislocation of the shoulder joint. Where’s the fracture?
Lesser tuberosity of Humerus
Attachment of Subscapularis tendon
What are the structures affected in the Injury of the surgical neck of the humerus?
Injury to Axillary nerve and Posterior Humeral Circumflex artery as they pass to the quadrangular space.
Structures affected in the injury of the shaft of the humerus?
Injury to the Radial nerve and the Deep Brachial Artery in the spiral groove.
Common scenario: Child undergoes FOOSH with partially flexed elbow. What type of fracture and structures affected?
Supracondylar fracture of the humerus.
Injury to the Median Nerve.
Structure/s affected in the fracture of the Medial Epicondyle of the humerus?
Injury to Ulnar Nerve.
Neurovascular Pairing: Name the corresponding Arteries & Nerves
Location: Axilla/ Lateral Thorax
Nerve: Long Thoracic
Artery: Lateral Thoracic
Neurovascular Pairing: Name the corresponding Arteries & Nerves
Location: Surgical Neck of Humerus
Nerve: Axillary
Artery: Posterior Circumflex
Neurovascular Pairing: Name the corresponding Arteries & Nerves
Location: Mid-shaft of Humerus
Nerve: Radial
Artery: Deep Brachial
Neurovascular Pairing: Name the corresponding Arteries & Nerves
Location: Distal Humerus Cubital Fossa
Nerve: Median
Artery: Brachial
Neurovascular Pairing: Name the corresponding Arteries & Nerves
Location: Distal Humerus - Popliteal Fossa
Nerve: Tibial
Artery : Popliteal
Neurovascular Pairing: Name the corresponding Arteries & Nerves
Location: Posterior to Medial Malleolus
Nerve: Tibial
Artery: Posterior Tibial
Nerve affected in Humeral Surgical Neck Fracture?
ARM-U
NAMe SOME
Axillary Nerve (C5-C6)
Neck Fracture
Nerve affected in Axilla & Midshaft Fracture?
ARM-U
NAMe SOME
Nerve: Radial Nerve
Nerve affected in Supracondylar Fracture?
ARM-U
NAMe SOME
NERVE: Median Nerve ( C5-T1)
Nerve affected in Medial Epicondyle Fracture?
ARM-U
NAMe SOME*
Nerve: Ulnar Nerve
Fracture: Outstretched Fall - Medial Epicondyle
Dysfunction of nerves :
A in ARM-U?
Axillary Nerve: failure to Abduct (C5-C6)
Dysfunction of nerves :
R in ARM-U?
Radial (C5-T1) - Rist Drop (Wrist)
Dysfunction of nerves :
M in ARM-U?
Median Nerve (C5-T1)
Monkey hand / Ape Hand
Dysfunction of nerves :
U in ARM-U?
Ulnar Nerve (C8-T1)
Ulnar claw
Flat bones (3)
Skull
Ribs
Sternum
Where is an ellipsoidal joint located?
Wrist
Saddle joint is located at?
Carpometacarpal of the thumb
Attachment of pectoralis major?
Origin: Clavicle, Sternum, Upper six costal cartilages
Insertion: Lateral lip of bicipital groove of humerus
Nerve supply: Medial and lateral pectoralis nerves
Action: Adduction, Internal rotation of arm, flexion of arm ( clavicular fibers)
Rotator cuff muscles ? (4)
SITS
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
Shoulder dislocation, what joint is affected?
Acromioclavicular joint
Shoulder girdle components? (3)
Scapula
Clavicle
Manubrium of Sternum
Content of Quadrangular Space?
Axillary Nerve and
Posterior Circumflex Humeral Vessels
Innervation of anterior compartment of arm?
Musculocutaneous nerve
Main supinator of arm?
Biceps brachii
Main flexor of the arm?
Brachialis
Common origin of flexor tendon?
Medial epicondyle of Humerus
Muscles commonly affected in tennis elbow or lateral epicondylitis?
Extensor carpi radialis brevis
Muscles commonly affected in golfers elbow or medial epicondylitis?
Pronator teres
Flexor carpi radialis
Description about Elbow joint ?
- Hinge joint
- Articulations:
- trochlear notch of the ulna and the trochlea of the humerus
- head of the radius and the capitulum of humerus
Normal carrying angle of the elbow?
Male: 170 degrees
Female: 167 degrees
Elbow joint is extended and lies between the arm and forearm
Angle disappears when the elbow joint is flexed
Movement of radioproximal joint?
- Rotary movements of the forearm
- When the arm is in the resting position beside the body, the range of motion for pronation is 61-66 degrees, while supination it is 70-77 degrees.
What fracture affects the lateral epicondylitis?
Tennis elbow
Hypothenar muscles innervation?
Ulnar nerve
Abduct fingers?
Dorsal interossei
Innervates deltoid and teres minor?
Axillary nerve
Contents of the anatomic snuff box?
Apex: point towards the thumb
Base: distal to the end of radius
Floor: Scaphoid, Trapezium
Lateral: Abductor pollicic longus, extensor pollicis brevis
Medial: extensor pollicic longus
De quervain tenosynovitis affects? (2)
Absuctor pollicis longus
Extensor pollicis brevis
APpLe EPol Bre red
Lesion of C5 - C6 upper brachial plexus injury. With proximal musculature affected, arm medially rotated and forearm pronated.
MOI: fall on shoulder, difficult delivery of infant
Erb- Duchenne Syndrome
A benign proliferative disorder characterized by decreased hand function caused by hand contractures and painful fascial nodules?
Dupuyteren’s Disease / Contracture
Fracture of surgical neck of humerus?
Axillary nerve
Lesion of C5 and C6 Waiters Tip?
Erb Duchenne Syndrome
Describe Erb-Duchenne Syndrome. (3)
- C5-C6 lesion, Upper brachial plexus injury
- Proximal musculature affected: arm medially rotated and forearm pronated
- MOI: Fall on shoulder , difficult delivery of infant
A benign proliferative disorder characterized by deceeased hand function caused by hand contractures and painful fascial nodules.
Dupuytren’s Disease / Contracture
Supracondylar fracture of humerus?
Median nerve
Fractures of proximal humerus and humeral shaft?
Radial Nerve
Medial epicondyle fracture of humerus?
Claw hand - Ulnar nerve injury
Spiral fracture of midshaft of humerus?
Wrist drop - Radial Nerve Injury
Structure in spiral groove of humerus?
Radial nerve
Claw hand?
Ulnar nerve
Waiter’s tip / Erb Duchenne Palsy.
Upper trunk of brachial plexus
Hand of benediction
Median nerve
Ape hand deformity
Median nerve
Wrist drop .
Radial nerve
Cubital tunnel syndrome
Ulnar nerve
Radial tunnel syndrome
Deep branch of Radial Nerve
Carpal tunnel syndrome
Median nerve
Tunnel of Guyon
Ulnar nerve
First bone to begin ossification and last one to complete ossification?
Clavicle
Fracture of the Fibular Head?
Common peroneal nerve
Fracture of the distal radius with the fragment displaced volarly?
Smith
DR Smith - Distal Radius
Fracture of the radial styloid
Hutchinson/ Chauffeur
Fracture of the ulna and dislocation of the radial head?
Monteggia
Fracture of the distal radius with dislocation of distal radioulnar joint.
Galeazzi
Fracture of the radial shaft at the junction of the middle and distal thirds without an associated fracture of the ulna.
Piedmont
Fall on outstretched hand, distal radial fracture , fragment dorsally placed.
Colle / Dinner/ Silver fork deformity
Rucksack palsy
Long thoracic nerve
Scapular winging
Long thoracic nerve
Saturday night palsy
Radial nerve
Olecranon fossa receives the olecranon process of the ulna during ________.
Extension of the arm
Dermatome levels:
C6
Thumb
Dermatome levels:
C8
Small finger
Dermatome levels:
T4
Nipple
Dermatome levels:
T10
Umbilicus
Dermatome levels:
L4
Knee
Exaggeration in sagittal curve in thoracic.
Kyphosis
Vertebral level of iliac crest and bifurcation of aorta
L4
Characteristic feature of 2nd cervical vertebra
Odontoid process
Spinal cord at birth ends in what level
L3
Promotes flexor and inhibits extensor activity
Rubrospinal
Bilateral motor paralysis, loss of pain and temperature.
Anterior cord
Boundaries of triangle of auscultation. (3)
Trapezius
Latissimus dorsi
Medial border of scapula
Most dislocated carpal bone.
Lunate dislocation
Localized thickening and contracture of palmar aponeurosis.
Dupuyteren conracture
Compression of the lower trunk of the brachial plexus and subclavian vessels, most commonly within the scalene triangle.
Thoracic outlet syndrome
Shallow depression formed with articulation between humerus and scapula.
Glenoid cavity
Type of joint:
Elbow joint
Synovial Hinge joint
Strongest flexor of thigh
Iliopsoas
Origin of rectus femoris
Anterior Inferior Iliac Spine
Origin of Sartorius and Tensor fascia lata
ASIS
Innervation of posterior compartment of the thigh.
Sciatic nerve
Adductor canal
Saphenous nerve
Anterior tarsal tunnel syndrome
Deep peroneal nerve
Posterior tarsal tunnel syndrome.
Tibial nerve
Muscle of the thigh with dual innervation.
Adductor Magnus
Femoral sheath is formed by?
Fascia transversalis and Fascia Iliaca
Most lateral structure within femoral sheath
Femoral artery
Most lateral structure within femoral triangle
Femoral nerve
Waddling gait
Superior gluteal nerve
Trendelenburg sign
Superior gluteal nerve
Piriformis syndrome
Sciatic nerve
Intragluteal injections
Sciatic nerve
Foot drop
Deep peroneal nerve
Steppage gait
Deep peroneal nerve
Extensor of the thigh supplied by inferior gluteal nerve.
Gluteus maximus
Largest branch of lumbar plexus.
L2,L3, L4 - Femoral nerve
Waddling gait, weakness of Gluteus medius and minimus
Superior gluteal nerve injury
Intramuscular injection
Superolateral part of buttock
Eversion and plantarflexion of foot
Peroneus longus and brevis
Medial boundary of popliteal fossa.
Semimembranosus and Semitendinosus
Eversion and plantar flexion of the foot
Peroneus longus and brevis
Medial boundary of popliteal fossa.
Semimembranosus and Semitendinosus
Neck of hernial sac lies below and lateral to the pubic tubercle and medial to femoral artery and vein.
Femoral hernia
Neck of femoral hernia sac lies at the femoral ring and related anteriorly to the _______ ligament. Posteriorly to the __________ ligament and medially to the _______ ligament.
Anteriorly: Inguinal ligament
Posteriorly: Pectineal ligament
Medially: Lacunar ligament
Tendon reflexes:
Biceps brachii
C5
Tendon reflex :
Brachioradialis
C6
Tendon reflex :
Triceps brachii
C7
Tendon reflex :
Patellar tendon
L4
Tendon reflex :
Achilles Tendon
S1
Foot drop
Common Peroneal Nerve Injury
Posterior displacement of femur on tibia; LAX during flexion
Anterior Cruciate Ligament
Ligament of the knee located in the center that controls the rotation and forward movement of the tibia.
Anterior cruciate ligament
Ligament of the knee located in the center that controls the rotation and forward movement of the tibia.
Anterior cruciate ligament
Unhappy triad of injuries ( O’ Donoghue )
ACL, MCL, Medial Meniscus
Tibia bent medially, rupture of lateral / fibular collateral ligament.
Genu varum ( Bow Leg)
Part of the knee injured by a medially directed force from the lateral side ( valgus stress)
Medial collateral ligament
Part of the knee injured by a leterally directed force or force from the medial side ( varus stress)
Lateral Collateral ligament
Anterior displacement of tibia over the femur.
ACL injury
Extrinsic muscles of the back that do not contribute to the limb movements.
Serratus posterior superior
Serratus posterior inferior
Largest branch of the sacral plexus?
Sciatic nerve
Largest branch of the brachial plexus?
Radial nerve
Largest branch of the lumbar plexus?
Femoral nerve
Largest branch of the lumbo-sacral plexus?
Sciatic nerve
Largest bone of the foot?
Calcaneum
Largest bone carpal bone?
Capitate
Largest carpal bone in the proximal row?
Scaphoid
Largest carpal bone in the distal row?
Capitate
Bones contributing to the arches of the foot?
Medial arch (9)
- Calcaneus
- Talus
- Navicular
- Three Cuniforms
- First three metatarsals
Met Three Cute Ca Ta Na
Bones contributing to the arches of the foot?
Lateral arch (4)
- Calcaneus
- Cuboid
- 4th Metatarsal
- 5th Metatarsal
Met 4-5 Caloric (Chubby) Cub
Calcaneus is present in both medial & lateral arch
Bones contributing to the arches of the foot?
Transverse arch (5)
- Metatarsal bases
- Cuboid
- Three cuneiform bones
Met 3 Cute Cubs
Function of the meniscus?
Even out weight distribution of the body weight from the femur to the tibia ( inner 2/3 is avascular)
Skeletal components involved in the unhappy triad include (3)
Patella
Femur
Tibia
Unhappy Thin Skeleton of Phineas and Ferb
Ligaments AMM : ACL , MCL, Medial Meniscus
Muscle strengthened to help alleviate pain in unhappy triad injury.
Hamstrings