Upper Extremity Clinical Notes Flashcards
Greenstick fracture
- where
- what causes it
incomplete fractures in the clavicle
- most common in young children
- occur from falling
most common fracture site on humerus
surgical neck
cause of “funny bone” pain
compression of the ulnar nerve in the groove for the ulnar nerve in the humerus
avulsion of the medial humeral epicondyle
small break in the humerus bone; caused by severe abduction of the extended elbow
“fractured elbow”
fracture of the olecranon; commonly caused from falling; considered an avulsion fracture because of the forceful nature of the triceps brachii m.
Colle’s fracture
fracture of the distal end of the radius from breaking a fall
- styloid process of ulna is often avulsed in this situation as well
most commonly fractured carpal bone
- mechanism
the scaphoid; usually the result of trying to break a fall
- often the fracture is not visible on x-ray and misdiagnosed as severe sprain
carpal tunnel syndrome
swelling in the tendons which causes the median nerve to become compressed in the carpal tunnel
- produces parasthesia, anesthesia, and pain
the passage anterior to the carpal bones posterior to the flexor retinaculum is knows as the
carpal tunnel
compression in the guyon tunnel causes _____
loss of sensation and muscular weakness due to compression of the ulnar nerve
guyon tunnel (ulnar canal)
the depression between the pisiform and the hamulus of the hamate
boxer’s fracture
fracture of the head of the 5th metacarpal; caused when an individual punches something with a closed fist
closing fingers in a door can cause _____
fractures in the distal phalanges; bone fragments must be realigned carefully to maintain function
what injury can occur in individuals who repeatedly throw balls, such as pitchers
glenoid labrum tear; in response to sudden contraction of the biceps brachii muscle in the anterosuperior part of the labrum
“shoulder separation”
injury and separation of the acromioclavicular joint
- is capable of separating w/ or w/o rupture of coracoclavicular ligament
glenohumeral joint dislocations
- why is it susceptible to dislocation
- how does it most commonly occur
the joint is suceptible to dislocation due to its mobility and relative instability
- most commonly occurs anteriorly or inferiorly
elbow dislocations
- how does it occur
occurs posteriorly in response to force transmitted along the long axis of the forearm
- usually involves tear in ulnar collateral ligament
“student’s elbow”
“dart thrower’s elbow”
“miner’s elbow”
subcutaneous olecranon bursitis (inflammation of the subcutaneous olecranon bursa)
- results from excessive friction between skin and olecranon
“Nursemaid’s elbow”
“Pulled elbow”
when the radial head is dislocated out of the annular ligament
- typically occurs from pulling on the arm of a child
“skier’s thumb”
“game-keeper’s thumb”
laxity or rupture of both collateral ligaments of the 1st metacarpophalangeal joint which results in a hyperabduction of that joint
“Baseball finger”
“mallet finger”
sudden hyperflexion of the distal interphalangeal joint
- causes avulsion of the attachment of the long extensor tendon with the tendon away from the distal phalanx
“bull-rider’s thumb”
sprain of the lateral collateral ligament and avulsion of the lateral part of the proximal phalanx of the thumb
Synovial cyst
ganglion cyst
when the synovial sheaths are irritated and an accumulation of mucopolysaccharide fluid occurs
- infections can cause swelling
Dupuytren contracture
thortening, thickening, and fibrosis of the palmar aponeurosis and palmar fascia which results in a partial flexion of the 4th and 5th digits
“winged” scapula
paralysis of the serratus anterior muscle usually as a result of injury to the long thoracic nerve
rotator cuff injuries
trauma results in instability of the glenohumeral joint
- supraspinatus is most commonly injured
bicipital myotactic reflex failure indicates injury to what
musculocutaneous nerve or C5 and C6 anterior rami
bicipital myotactic reflex
is produced when striking the thumb placed over the bicipital tendon with a reflex hammer
- tendon will tighten up and forearm will flex
biceps tendinitis
inflammation to the biceps tendon secondary to repetitive movement of the long head of the tendon through the intertubercular groove
popeye deformity
muscle balling up in the mid arm secondary to the biceps tendon dislocating out of the intertubercular groove or separating entirely from the supraglenoid tubercle
tennis elbow
results from repetitive use of the superficial extensor muscles of the forearm
- involves pain over the lateral epicondyle and down the posterior forearm
lateral epicondylitis
results from repeated flexion and extension of the wrist which strains the periostium of the later humeral epicondyle
injuries to the median nerve can cause what in the thumb
inability to oppose the thumb
recurrent branch of median n.
Erb-Duchenne Palsy
“Waiter’s tip position”
upper plexus injury; affects C5 and C6 anterior rami; individuals will have an adducted and medially rotated arm and an extended elbow; caused by dramatically increasing the angle between neck and shoulder
“claw hand”
Klumpke paralysis
inferior brachial plexus injury; affects the short muscles of the hand; individuals make a claw when they try to make a fist
Compression of the cords of the brachial plexus
- result from
- clinical findings
results from prolonged periods of working with the upper limb extended over the head
- results in pain radiating down the arm, loss of sensation, tingling of arms, and weakness of the hands
injury to the musculocutaneous nerve
renders the anterior brachial muscles paralyzed
- rare but possible with blunt force trauma
injury to the axillary nerve
results in atrophy of the deltoid muscle and loss of sensation over the superolateral arm
injury to the median nerve
- “Ape’s Hand”
- “Hand of Benediction”
results in adducted thumb and thenar eminence atrophy (ape’s hand)
inhibits flexion of 2nd and 3rd digits (hand of benediction)
injury of the ulnar nerve normally occurs in what four places
- posterior to the medial humeral epicondyle
- between ulnar and humeral heads of flexor carpi ulnaris muslces
- at the wrist
- in the hand
handlebar neuropathy
sensory loss on medial side of hand and weakness of intrinsic hand muscles
- result of ulnar nerve compression when pressure is placed on the hamulus of the hamate bone, like when riding a bike
wrist drop
injury of the radial nerve
- impairment of elbow extension and thumb adduction and extension
why is the distal fragment of bone susceptible to avascular necrosis in scaphoid fractures
it is usually separated from its blood supply in the fracture
what is the carpal tunnel
- contents
- anterior and posterior borders
- the tendons of flexor digitorum profundus and superficialis tendon of flexor carpi radialis, and median nerve
- passing anterior to carpal bones and posterior to flexor retinaculum
Guyon Canal (Ulnar Canal)
the depression between the pisiform and hamulus of the hamate where the ulnar n. passes through
muscles of the rotator cuff
supraspinatus m.
infraspinatus m.
teres minor m.
subscapularis m.
3 borders of the snuff box and contents
abductor pollicis longus m., extensor pollicis brevis m., and
extensor pollicis longus m.
contents: radial a. and superficial radial n.
which region of the axillary a. is susceptible to aneurysm and in what patients
region 1
- patients who have experienced repeated rapid arm movements (baseball pitchers)
- can compress brachial plexus resulting in pain and loss of sensation
most common site of venipuncture and why
medial cubital vein
- its superficial location and the protection of underlying deep structures by the bicipital aponeurosis
