- can't abduct thumb - median nerve injury

Upper limb Flashcards by Sophie Baird

What is the shoulder girdle formed of?

scapula
clavicle
proximal humerus
supporting muscles including the deltoid and rotator cuff muscles

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Where do the muscles of the rotator cuff attach and what action do they perfom?

attach to greater tuberosity=

supraspinatus: initiation of abduction
infraspinatus: external rotator
teres minor: external rotator

attach to lesser tuberosity=
- subscapularis: internal rotator

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What is important to ask if people have pain in their shoulder?

elbow pain

neck pain

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What is acute calcific tendonitis?

acute onset of severe shoulder pain with calcium deposition in the supraspinatus tendon

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How is acute calcific tendonitis treated?

subacromial steroid

- local anaesthetic injection

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What are the referred shoulder pain problems?

angina
neck problems
diaphragmatic irritation (biliary colic, hepatic or subphrenic abscess)

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What are the ways that the axillary nerve can be damaged?

humeral dislocation

- fracture of the humerus

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What does the axillary nerve pass through?

the quadrangular space: teres minor on top, teres major on bottom, humerus and long head of biceps brachii and sides

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What results from axillary nerve damage?

teres minor: lateral rotation
deltoid: abduction of the arm
cutaneous innervation: badge patch area

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What does the radial nerve supply and what can disrupt it?

supplies posterior arm and forearm

- can be disrupted by mid humerus fracture

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What does the radial nerve split into?

superficial branch (S)
posterior interosseous nerve (M): goes into supinator so hypertrophy of this compresses it (screwing with extended arm)

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What is damage to the radial nerve seen as clinically?

wrist drop

no finger extension

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What is the location of the median nerve?

runs within the cubital fossa

- TAN: biceps brachii tendon, brachial artery and medial nerve

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What can affect the median nerve?

elbow dislocation

- it pierces pronator so using this muscle can hurt it (screwing other way)

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What are the features of the flexor digitorum superficialls?

2-5
flexes PIP
median nerve

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What are the features of the flexor digitorum profundus?

2-5
flexes DIP
ulnar medially and interosseous laterally

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What are the features of the flexor pollicis longus?

flexes thumb

- anterior interosseous

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What innervates the thenar eminence?

recurrent median

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What are the features of the lumbricals?

flex MCP and extend PIP and DIP

- ulnar and median innervation

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What is ape hand?

can’t abduct thumb

- median nerve injury

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What is hand of benediction?

median nerve cut up at elbow
thumb can’t move
lumbricals, FDS and FDP not working
thumb and radial fingers can’t make a fist

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What is the ulnar nerve paradox?

cut at elbow: FDS is not working
cut at wrist: FDS not working, lumbricals not working
for two ulnar digits

How many views of the upper limb are needed on XR?

two normally
3 for spine
4 for scaphoid

What is avulsion?

a tearing off injury

What are comminutive fractures?

several pieces

What are displaced fractures?

no continuity between the ends

What things can mimic acute avulsion fractures?

- sesamoid bones - accessory ossification centres - old non-united fractures

What is the posterior fat pad sign?

due to displaced fat pat due to trauma which causes an effusion which is very bad

What are the features of children's fractures?

- their bones bend or bow - there are incomplete fractures called greenstick fractures - growth plate is a weak point which is prone to injury - use Salter-Harris guidelines

What are examples of bony rings that can break?

- spinal canal - pelvis - forearm - lower leg !!NB these can break in more than one place

What is the best XR view for a posterior shoulder dislocation?

oblique view | hard to see on AP

What are the things to look for on an XR for a supracondylar fracture?

- visible posterior fat pat helps - always check humerocapitellar alignment - careful of brachial artery damage

What can be the result of a scaphoid fracture?

can lead to avascular necrosis and then early wrist OA | !!NB these aren't visible until after 10 days

What is a Bennett's fracture?

- involves the articular surfaces of first metacarpal base | - tendons cause deformity, dysfunction and arthritis if untreated

What are the features of a subungual haematoma?

- painful - blood release is necessary - nail will fall off and grow back

What is skiers thumb?

partial or complete rupture of ulnar collateral ligament of MCPJ

What is mallet finger?

- extensor ten don tear so there is recited extension and tenderness - splint for 6 weeks 24/7 - occasional fix with wire

What is the treatment for a PIPJ dislocation?

- pop back into place - needs strapped - delayed presentation is very bad

What is a Bennett's fracture?

- base of thumb | - need to ensure articular surface is returned otherwise there is OA

What is the treatment for burns in the hand?

- excise the damaged skin | - mobilise aggressively

What is eschar?

thick, leathery inelastic skin after burns which might need surgical release to allow movement

What are the main predisposing factors for tendon problems both intrinsic and extrinsic?

- intrinsic= age, gender, obesity, RA, anatomical malalignment - extrinsic= trauma, repetitive injury, drugs eg steroids and antibiotics

What are the features of tendonosis?

- degeneration of collagen and extra-cellular matrix - due to MMPs - can be present with no pain - manage conservatively (injections, NSAIDs, rest and physio) or surgically (decried, decompress, synovectomy and tendon transfer)

What is the general rule for injecting steroids in the body?

- inject in the upper limb | - don't inject in the lower limb

What is the extensor origin of the elbow?

lateral epicondyle

What is the flexor origin of the elbow?

medial epicondyle

What are the features of arthritis in the elbow?

- only after trauma - radio-capitellar joint= surgical excision of radial head - severe needs a total elbow replacement but then there will be weight restriction

What is the treatment for OA at the thumb base?

- steroid injection fot flares | - fusion/excision for chronic issues

What is a Swan neck deformity?

``` PIP = hyperextension DIP = flexion ```

What is a Boutonniere deformity?

``` PIP = flexion DIP = hyperextension ```

Where are the most common places for a ganglion cyst?

``` hand wrist foot ankle knee (Baker) ```

What phase of Dupuytren's contracture involves development of nodules and myofibroblasts?

active contractile phase

What are the phases of Dupuytren's contracture?

- proliferative phase: high concentration of immature myofibroblasts and fibroblasts arranged in a whorled pattern - involution phase: aligned fibroblasts in the longitudinal axis of the hand following lines of tension - residual phase: acellular collagen-rich chords remain causing contracture deformity

What causes a claw hand?

ulnar nerve deformity