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Upper Extremity Flashcards

1
Q

segments of the arm

A

-4 segments
-shoulder- pectoral girdle
-arm- anterior and posterior
-forearm- anterior posterior
-hand- wrist palm, dorsum, digits

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2
Q

bones

A

-pectoral girdle
-upper extremity
-forearm
-wrist

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3
Q

pectoral girdle

A

-scapula
-clavicle
-6 muscles- movement of girdle and stabilization of the scapula
-elevation, depression, protraction (hunch), retraction
-serratus anterior, rhomboid major and minor, trapezius, subclavius, pectoralis minor, levator scapulae

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4
Q

fracture of clavicle

A

-direct fall on shoulder or indirect force
-sternocleidomastoid elevates medial part
-trap is unable to hold up the lateral part of clavicle bc the weight of the arm -> depressed
-may also be pulled medially bc of pectoralis major
-middle- MC fracture- thinnest
-any force can cause dislocation- ligaments
-MC displacement- proximal fragment displaces superior bc its pulled on by sternocleidomastoid
-lateral displacement- weight of arm pulls it down -> caudal displacement
-non-union of these fractures -> 15%*

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5
Q

clavicle defect

A

-dont mistake epiphysis at acromial end of clavicle for fracture
-fusion of ossification center fails -> bony defect on lateral side -> this is bilateral condition -> To differentiate between fracture graph both sides

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6
Q

fracture of scapula

A

-severe trauma
-MVA
-protected by muscles of both sides

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7
Q

fractures to humerus

A

-MC in elderly with osteoporosis
-proximal head fracture- osteoporotic/fragility fracture
-surgical neck
-even a fall on hand can cause
-direct blow- mid shaft transverse fracture
-supraepicondylar (supracondylar) fracture- distal humerus fracture -> usually in child falling on hand
-nerve injury with fracture:
-surgical neck- axillary**
-radial groove- radial nerve
-distal humerus- median nerve
-medial epicondyle- ulnar nerve

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8
Q

osteoporotic/fragility fractures

A

-distal radius fracture
-proximal head fracture of humerus (surgical neck)
-vertebral compression fracture

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9
Q

fractures of ulna and radius

A

-direct- transverse injury to both at same level
-interosseous membrane binds these bones -> dislocation of nearest joint with fracture

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10
Q

colles fracture

A

-complete fracture of distal 2cm radius
-MC forearm fracture
-comminuted
-forced dorsiflexion
-ulnar styloid is often avulsed (broken off)
-dinner fork deformity- distal radius fragment projects posteriorly -> creates dinner fork shape
-radius shortens

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11
Q

fracture of hand

A

-27 bones in hands, wrist, palm, digits
-scaphoid is MC- fall on palm with hand abducted
-may not show on imaging at first
-can cause avascular necrosis of proximal fragment of scaphoid -> degenerative joint disease of wrist
-hamate fracture- may damage ulnar artery/nerve

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12
Q

pelvic girdle innervation

A

-rhomboids- dorsal scapular
-levator scapulae- dorsal scapular
-pectoralis minor- pectoral nerves
-serratus anterior- long thoracic
-subclavius- subclavian nerve
-trapezius- accessory

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13
Q

pectoral gridle movement

A

-pectoralis minor- protraction
-subclavian- stabilizes and depresses

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14
Q

clavicle

A

-joins two different skeletal system
-appendicular and axial
-rigid support for scapula and free limb
-protection to neurovascular bundle
-transfer shock from upper limb to axial skeleton -> without this we would fracture with trauma to arm

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15
Q

structures neighboring clavicle

A

-above- thoracic inlet- vital structures pass behind
-thoracic outlet syndrome- compression of structures

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16
Q

shoulder separation

A

-tear or a stretching of ligaments around shoulder
-complete tear- surgical repair -> AC and CC rupture
-partial- immobility will heal MC
-affects the positioning of the structures
-clavicle displaces posterior over acromion
-clavicle displaces just under skin -> coracoidclavicular and acromioclavicular tear
-clavicle underneath coracoid (very rare)
-Acromioclavicular ligament and Coracoclavicular ligament

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17
Q

rotator cuff

A

-these muscles help humerus SIT in the glenoid fossa
-subscapularis
-infraspinatus
-teres minor
-supraspinatus
-humoral head- sits in glenoid fossa (made from scapula)

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18
Q

shoulder joints

A

-TRUE JOINTS (anatomical):
-sternoclavicular joint
-acromioclavicular joint
-glenohumeral joint
-FALSE JOINT (physiological):
-scapulothoracic joint- space between
-suprahumeral (subacromial)- space above humeral head

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19
Q

rotator cuff tear

A

-primary action is to balance the tension around glenohumeral joint
-glenohumeral joint is very flat -> has a little labrum (cartilage) that buckles up but is very easy to tear
-only thing securing humeral head from going off balance is rotator cuff muscles
-MC- supraspinatus -> trouble with abduction
-2 causes- MC extrinsic compression (wear and tear) OR intrinsic degeneration (years of rotator cuff tendon wear -> blood supply decrease -> tear)

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20
Q

rotator cuff action and innervation

A

-supraspinatus- only one that doesnt rotate shoulder -> major abductor
-after 15 degrees abduction -> deltoid takes over
-subscapularis- medial rotation
-infraspinatus and teres minor- lateral/external rotation
-teres minor - axillary nerve
-supraspinatus, infraspinatus- suprascapular nerve
-subscapular- subscapular nerve

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21
Q

muscles that flex and extend the shoulder

A

-pectoralis major- flexion
-latissimus dorsi- extension
-deltoid- 3 heads
-teres major- extends
-tendons running in the bicipital groove- lady and 2 majors -> pec major (anterior), lat, teres major (posterior)
-bicep tendon runs over top

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22
Q

deltoid actions

A

-3 functions bc 3 heads
-clavicular- flexion
-acromial- abduction
-scapular- extension
-axillary nerve

23
Q

ligaments of shoulder

A

-help hold humerus in glenoid fossa
-labrum- cartilage ring- hold loosely in ring -> stabilized by muscles and ligaments
-slap tear- superior labrum tear from anterior to posterior- MC -> bicep tendon inserts
-quickly lift, fall on hand -> bicep popping off and curling up

24
Q

shoulder dislocation

A

-less muscle in this area- MC area -> anterior
-anterior dislocation - humerus move forward anteriorly -> falling on extended arm
-posterior- head of humerus behind the socket, uncommon -> serve shock, seizures
-inferior- arm pushed down and out of socket towards armpit

25
complications post shoulder dislocation
-recurrence- age, damage done -high recurrence with younger -> first time in younger children should be surgically repaired -fracture-humeral head- hillsachs fracture secondary to dislocation -nerve injury- axillary nerve -between the humerus and triceps long head -> 2 spaces -> quadrangular space and triceps hiatus -axillary nerve and posterior circumflex in quadrangular -triceps hiatus- radial nerve, profunda brachia artery
26
quadrangular space syndrome
-compression of axially nerve -pain over posterior lateral shoulder -numbness -vascular compromise of circumflex -young adults, no trauma -MRI- atrophy of teres muscle -> axillary nerve problem
27
subclavian artery
-subclavian artery over the first rib -> gives off superior thoracic artery in 1st segment -> once it hits pec minor -> becomes axillary artery -> gives off 2 branches in 2nd segment -> thoracoacromial and lateral thoracic arteries -3rd segment- posterior and anterior humeral circumflex artery and subscapular - at the level of surgical neck -past teres major -> axial becomes brachial artery -ex. elderly falls on hand -> breaks surgical neck -> posterior and anterior humeral circumflex arteries, subscapular, and axillary nerve are in danger
28
brachial artery
-brachial artery comes down and crosses over elbow joints -becomes radial and ulnar artery -ulnar artery -> interosseous branches- feed the deeper layers -injury to brachial artery -> compartment syndrome -> ischemia and paralysis to muscle -volkmans contracture
29
volkmans contracture
-occurs after injury to elbow or upper arm -usually crush injury -brachial artery damage -pt goes into acute compartment syndrome -if untreated- contracture of muscles -> permanent deformity -> flexion of fingers and wrists -ischemia and paralysis of muscles -can also happen with brachial plexus injury (less common)
30
flexors of arm
-anterior compartment -biceps brachii- shoulder and elbow supination (crosses over several joints) -brachialis- elbow -coracobrachialis- shoulder -musculocutaneous nerve
31
biceps tendon
-attaches below elbow -testing reflex -C6 spinal nerves being tested
32
arm extensors
-posterior compartment -innervated by radial nerve -triceps branchii- long, medial, lateral head -> all combine to attach to olecranon of ulna -anconeus- humerus to ulna -long head- adduction and extension of shoulder***
33
elbow
-7 major muscles- biceps tendon, triceps, brachialis, brachoradialis, aconeus, pronator teres, pronator quadratus -3 flexors -2 extensors -2 rotate forearms- pronator teres and supinator -9 muscles cross elbow to work on hand and metacarpals
34
ligaments of elbow
-radial collateral -ulnar collateral -annular- over radial head -tennis elbow- lateral epicondylitis pain -> occurs with extension of wrist or fingers -> pain over lateral epicondyle -ulnar collateral tear- repeated pitching and twisting -> constant pain from overuse -tommy john surgery- UCL tear repair -annular ligament disruption- over radial head ->fracture or subluxation of radial head -subluxation of radial head- nurse maids elbow
35
supination of arm
-supinator -biceps brachii (assist)
36
pronator of arm
-pronators teres -pronator quadratus -brachioradialis (assist)
37
elbow joint: composite hinge joint
-humeroulnar joint- composite hinge joint -> flex and extend -> wrench (olecranon of ulna) and nut (trochlea of humerus) -humeroradial joint- ball and socket- pronation and supination -radioulnar joint- pivot joint- prevents spinning out of control (excessive pronation/supination) -> prevents nurse maid elbow dislocation -3 joints -humeroulnar joint: -olecranon and humerus- olecranon wraps 180 degrees around humerus -olecranon and ulna -> wrench around nut -> stable -> flex and extend
38
subluxation vs dislocation of elbow
-dislocation- force that pushes radial and ulnar out of joint and dislocate posteriorly -humeral head out of olecranon- extreme force -subluxation- bones are in tract with each other but out of communication with each other -> abrupt pulling, swinging child, pulling by arm -> radial head splits out from under the annular ligament -> decrease stability of pivot joint NURSE MAIDS!! -cant bend wrist -relocating subluxed radial head- palm up and bending at elbow
39
forearm
-4 compartments -anterior (flexor and pronators) and posterior (extensor) compartment -superficial and deep compartment -posterior- has dorsal and henrys mobile wad compartment
40
anterior compartment of forearm
-3 wrist flexors- flexor carpi radialis, palmaris longus, flexor carpi ulnaris -3 finger flexor- flexor digitorum superifcialis, flexor digitorum profundus, flexor pollicis longus -pronator quadratus- anterior deep compartment -> pronate forearm -ALL ARE MEDIAN NERVE EXCEPT flexor carpi ulnaris (ulnar nerve)
41
posterior compartment of forearm
-3 muscles in the lateral compartment for mobile wad of henry- extensor carpi radialis longus, extensor carpi radialis brevis brachioradialis -> most mobile movement of muscles -> easy to retract these for surgery -all innervated by radial nerve -all originate on lateral epicondyle
42
acromioclavicular joint
-joins the clavicle and acromion process -AC ligament- usually doesnt require surgical repair unless severe -coracoclavicular ligament -tears are based on the damage at these ligaments -nerves- lateral pectoral and axillary
43
sternoclavicular joint
-ball and socket -posterior rotation- external rotation of shoulder -protraction and retraction -elevation and depression
44
frozen shoulder
glenohumeral
45
clavicle injury
-carrying his arm for comfort -> signals immobilization helps -> signals bigger problem -hand dominance is important to note -nondisplaced fracture- no angle of fracture -posterior displacement of clavicle- numbness, diminished pulses, ischemia of limb
46
forces on the clavicle
-sternocleidomastoid pulling up -pectoralis pulling medially -trapezius is pulling up -weight of arm pulling down -coracoclavicular ligaments pulling
47
clavicle repair
-plate and screw on both ends of clavicle -causes so much discomfort sometimes even -union is more common (or uncommon?) in younger (they move a lot) -depending on angle -need to be immobile for union
48
elbow dimpling
-epicondyles misplaced -forearm appears looks longer -radial head displaced -especially worried about ulnar nerve
49
dermatomes
-ulnar nerve injury- pinky decreased sensation -median nerve- middle hand and tops of middle fingers -radial- dorsum parts of hand and thumb
50
ulnar nerve
-motor to intrinsic and extrinsic muscles -loss of extension -> flexion takes over -weakened intrinsic -> -cant extend the pinkys -> exaggerated flexion -flexor digitorum profundus and flexor digitorum superficialis -> not innervated by ulnar -> take over -> excessive flexion of PIP and DIP joints -ulnar claw hand
51
forearm fracture
-distal radial fracture -ulna dislocation -interosseous muscle sheared -severe pain with movement of fingers -fingers are cool to touch, decreased sensation of 2nd and 3rd digits -> median nerve injury -progression of these symptoms shows -> compartment syndrome -must relieve or else permanent damage
52
compartment syndrome
-5 Ps -Pain with passive movement (someone else is moving it and there is pain) -Paresthesia -Pallor -Paralysis -Pulselessness -3 As (for peds) -increase analgesic -Anxiety -Agitation
53
stryker pressure monitor
-assess compartment pressure

Anatomy (34 decks)

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