Upper Limb Flashcards
1
Q
Which view other than AP, is required for shoulder dislocation?
A
Axillary view
2
Q
which nerve is most commonly affected in shoulder dislocations?
A
axillary nerve
3
Q
what does the axillary nerve supply? (motor)
A
Deltoid, teres minor
4
Q
what does the axillary nerve supply? (sensory)
A
regimental badge area
5
Q
from what cord of the brachial plexus does the axillary nerve arise?
A
Posterior cord
6
Q
through which space does the axillary nerve pass?
A
quadrangular space
7
Q
what forms the superior border of the quadrangular space?
A
Teres minor
8
Q
what forms the inferior border of the quadrangular space?
A
Teres major
9
Q
what forms the medial border of the quadrangular space?
A
long head of triceps
10
Q
what forms the lateral border of the quadrangular space?
A
humeral shaft
11
Q
what structures pass through the quadrangular space?
A
Axillary nerve, posterior circumflex humeral artery
12
Q
what classification system is used for supracondylar fractures?
A
Gartland
13
Q
which neurological injury is most common in displaced supracondylar fractures?
A
Neuropraxia of anterior interosseous nerve (close to fracture site with soft tissue tethering)
14
Q
which muscles are supplied by the anterior interosseous nerve?
A
Flexor pollicis longus
Flexor digitorum profundus (radial 1/2)
15
Q
in the boast guidelines is absence of a radial pulse an indication for urgent surgery in supracondylar fractures?
A
Yes
16
Q
what size K wire should be used for supracondylar fracture fixation ?
A
2mm
17
Q
what are kanavels cardinal signs for flexor sheath infection?
A
- Fusiform swelling of digit
- Finger held in flexion
- pain on passive extension
- tenderness along flexor sheath
18
Q
which organisms commonly cause flexor sheath infections?
A
Staph aureus
Staph epidermidis (skin flora)
MRSA
19
Q
what is the origin of the FDS muscle?
A
Common flexor origin, adjacent part of the ulnar with a second part originating from the radius.
20
Q
where does FDS insert?
A
Middle phalanges
21
Q
where does FDP originate?
A
Interroseous membrane and part of the ulna
22
Q
where are the incisions made for a flexor sheath washout?
A
2 x transverse incisions over A1 & A5 pulley
23
Q
which two ligaments make up the coracoclavicular ligament?
A
Conoid ligament
Trapzeoid ligament
24
Q
which of the conoid or trapezoid ligament is most medial?
A
Conoid ligament
25
which 3 ligaments are at the medial end of the clavicle?
Interclavicular ligament
Costoclavicular ligament
sternoclavicular ligament
26
what are the muscular attachments of the clavicle?
Deltoid
Pec major
Trapezius
Subclavius
Sternocleidomastoid
Sternohyoid
27
which end of the clavicle is concave?
Acromial end
28
which end of the clavicle is convex?
Sternal end
29
what structures pass through the 2 heads of FDS in the forearm?
Median nerve
Ulnar artery
30
what nerve innervates FDP?
Anterior interosseous nerve (radial half)
Ulnar nerve (ulnar half)
31
in which compartment is FDS in the forearm?
intermediate
32
what are the 4 cardinal/Kanavels signs of flexor sheath infection?
Fusiform swelling
Held in flexion
pain on passive extension
tenderness along flexor sheath
33
where do you make the incisions for a flexor sheath washout?
Over A1 and A5 pulley
34
What radiographic sign is seen in posterior shoulder dislocation?
lightbulb sign
35
which structures are at risk in the FCR approach to the wrist?
Median nerve
Radial artery
36
which muscle lies underneath the FCR tendon?
FPL
37
which muscle must be lifted of the distal radius in FCR approach?
Pronator quadratus
38
which direction is the FCR commonly retracted?
Ulnarly (protect median nerve)
39
what position should a patient be placed for the deltopectoral approach to the shoulder?
Beachchair
40
what is the inter nervous plane for the deltopectoral approach to the shoulder?
Deltoid (axillary nerve)
Pec major (medial + lateral pectoral nerves)
41
which structures are at risk in the deltopectoral approach to the shoulder?
Musculocutaneous nerve
Axillary nerve
Cephalic vein
Anterior circumflex humeral artery
42
what steps are involved in superficial dissection of the deltopectoral approach?
Skin, fat, deltopectoral fascia, cephalic vein mobilised
43
what steps are involved in deep dissection of the deltopectoral approach?
Short head of biceps + coracobrachialis (conjoint tendon) retracted medially
Subscapularis partially cut
Capsule incision
44
where does the musculocutaneous nerve enter the biceps muscle?
5-8cm distal to the coracoid process
45
what is the superior border of the triangular interval?
teres major
46
what is the medial border of the triangular interval?
long head of triceps
47
what is the lateral border of the triangular interval?
humerus
48
what are the contents of the triangular interva?
radial nerve, profunda brachii artery
49
what is the superior border of the triangular space?
teres minor
50
what is the inferior border of the triangular space?
teres major
51
what is the lateral border of the triangular space?
long head of triceps
52
what are the contents of the triangular space?
circumflex scapular artery
53
what are the contents of the antecubital fossa?
Tendon of biceps
Brachial artery
Median Nerve
54
which structure is most medial in the antecubital fossa?
Median nerve
55
which structure if the most lateral in the antecubital fossa?
Tendon of biceps
56
which muscles make up the floor of the antecubital fossa?
Brachialis + Supinator
57
what is the lateral border of the antecubital fossa?
Medial border of brachioradialis
58
what is the medial border of the antecubital fossa?
Lateral border of pronator teres
59
what makes up the roof of the antecubital fossa?
Fascia and skin
60
which muscles originate from the medial epicondyle of the humerus?
Superficial Flexors
(Pronator teres, FCR, PL, FCU)
61
which muscle is considered to be in the intermediate compartment of the anterior forearm?
FDS
62
what muscles does the median nerve supply in the hand?
LOAF muscles:
- 1st + 2nd lumbricals
- Opponens pollicis
- Abductor pollicis brevis
- Flexor pollicis brevis
63
how do you test the function of Abductor pollicis brevis?
Place hand facing up on table, ask pt to point thumb to ceiling
64
what movements test all nerves in the hand?
- OK sign
- Cross 2 fingers
- Thumbs up
65
what areas does the median nerve supply sensation in the hand?
Skin of palm
Nail beds of radial 3.5 digits
66
what are the borders of the carpal tunnel?
roof - flexor retinaculum
floor - carpal bones
ulnar - pisiform + hook of hamate
radial - scaphoid tubercle + trapezium
67
what are the contents of the carpal tunnel?
median nerve
FPL
4 x FDS
4 x FDP
68
where is the palmar cutaneous branch of the median nerve given off?
5cm proximal to wrist
travels superficial to carpal tunnel
69
this definition describes what:
angle formed by a line drawn perpendicular to the axis of the radial shaft and a line that crosses along the radial intraarticular surface
volar tilt
70
what is a normal volar tilt?
11 degrees
71
what is a normal radial height?
11 degrees
72
the below describes what:
between 2 perpendicular lines - one at the level of the ulnar border of the radius and one at the level of the radial styloid
Radial height
73
the below describes what:
angle between a line drawn between the radial styloid and ulnar border of radius and a line drawn perpendicular to shaft/long axis of radius
radial inclination
74
what is a normal radial incliniation?
21 degrees
75
what alignment is considered acceptable in a distal radius fracture?
<3mm loss in radial height
<10 degree loss in volar tilt
<5 degree change in radial inclination
76
what is the internervous plane used in the FCR approach to the distal radius?
FCR - median nerve
FPL - AIN
77
what is the radial border of the anatomical snuffbox?
EPB + APL
78
What is the ulnar border of the anatomical snuffbox?
EPL
79
what forms the floor of the anatomical snuffbox?
Radial styloid, scaphoid, trapezium, base of metacarpal
80
what forms the roof of the anatomical snuffbox?
Deep fascia
81
what is the blood supply to the scaphoid?
Dorsal carpal branch of radial artery
82
what does the mnemonic CRITOL stand for with regards to ossification at the elbow?
C - capitellum 2y
R - radial head 4y
I - internal epicondyle 6y
T - trcohlea 8y
O - olecranon 10y
L - lateral epicondyle 12y
83
what does the mnemonic CRITOL stand for with regards to ossification at the elbow?
C - capitellum 2y
R - radial head 4y
I - internal epicondyle 6y
T - trcohlea 8y
O - olecranon 10y
L - lateral epicondyle 12y
84
what characteristics will a gartland I supracondylar fracture have?
Displacement <2mm
intact humeral line
85
what characteristics will a gartland II supracondylar fracture have?
Displacement >2mm
anterior humeral line disrupted
posterior cortex intact
86
what characteristics will a gartland III supracondylar fracture have?
displaced with periosteum torn and no cortical contact
87
what characteristics will a gartland VI supracondylar fracture have?
as with III but unstable in flexion and extension
88
what are flexor tendon sheaths?
Synovial sheaths surrounded by a fibrous later
89
what are the function of flexor tendon sheaths?
Synovial fluid provides nutrition and lubrication to tendons
Fibrous layer prevents bow stringing of tendons
90
what are the displacing forces in a clavicle fracture?
Medial - sternoclediomastoid
Lateral infero - pec major
Lateral - weight of arm
91
what is the allmann classification of clavicle fractures?
Grade I - middle 1/3
Grade II - Lateral 1/3
Grade III - Medial 1/3
92
what are the absolute indications for fixation in clavicle fractures?
Open Fracture
Subclavian artery/vein injury
displaced fracture with skin tenting
floating shoulder
symptomatic non union
93
what is a 'floating shoulder'?
ipsilateral clavicle and scapula neck fractures
94
what are the relative indications for fixation in clavicle fractures?
Brachial plexus injury
polytrauma
seizure disorder
closed head injury
unstable fracture pattern (neer IIA/IIB/V)
displaced >2cm shortening
95
how do you manage a clavicular non union?
asymptomatic - nothing
symptomatic - ORIF + bone graft
96
which muscles attach onto the olecranon?
Triceps - posterior aspect
Anconeus - Lateral aspect
97
what are the clinical features of a displaced olecranon fracture?
Bruising
Swelling
Palpable gap
inability to extend elbow
98
what is the usual mechanism for dislocating the elbow joint?
Hyperextension (axial load)
ie. fall on outstretched hand
rotational/valgus force in posterolateral direction
99
in what direction does the elbow usually dislocate?
Posterior
(posterolateral)
100
what steps take place to reduce a posteriorly dislocated elbow?
Traction
Supination
Flexion
Posterior pressure on olecranon
101
what is the post reduction management of a stable elbow dislocation?
Above elbow backslab - immobilise for 7-10 days
Early ROM
102
which soft tissue structures may need repair after a posteriorly dislocated elbow ?
LCL or MCL
103
which ligament is the first to go in a posteriorly dislocated elbow?
LCL
(MCL is last)
104
what is the terrible triad associated with elbow injurues?
Elbow dislocation (posterolateral)
Radial head fracture
Coronoid fracture
105
what are the static stabilizers of the elbow joint?
Ulnohumeral joint
Radiocapitellar joint
MCL
LCL
capsule
Flexor + extensor origins
106
what are the dynamic stabilizers of the elbow joint?
Triceps
Brachialis
Anconeus
107
what should be done prior to immobilisation after reduction of elbow dislocation?
elbow should be taken through ROM in flexion - extension plane to assess the stable range
108
what are gilulas carpal arcs?
used in assessment of normal alignment of carpys on PA wrist radiographs
109
what may disruption of gilulas arcs indicate?
Ligamentous injury or fracture at side of the broken arc
110
what neurovascular injury are patients with perilunate dislocations susceptible to?
Acute carpal tunnel syndrome
111
what do the boast guidelines state re dislocations with neurological symptoms?
need urgent relocation
112
what must you do after every reduction?
- repeat radiographs
- examine neurovascular status
- document findings
113
what is a bankart lesion?
Avulsion of anterior labrum
114
what is a bony bankart lesion?
fracture of anterior inferior glenoid
115
what is a hill sachs defect?
chondral impaction injury in the posteroseuprior humeral head secondary to contact with the glenoid rim
116
greater tuberosity fractures are associated with what type of shoulder dislocation?
anterior - >50y
117
lesser tuberosity fractures are associated with what type of shoulder dislocation?
posterior
118
a reverse hill sachs defect is what?
chondral impactio injury to anterior humeral head in posterior shoulder dislocations
