Upper Limb Clinical cases Flashcards
22 year old man had a Foosh and present in A+E on the same day with tenderness in the anatomical snuff box.
a) what bone is likely fractured?
b) when do you xRay
c) what is the risk and why?
a) scaphoid
b) same day and 10 days -2 weeks later (fracture sometimes only visible when active healing starts)
c) Avascular necorsis of proximal part, radial artery supply is distal to proximal.
Fractures at which site of the humerus will risk what nerve damage?
Intratuburcular- axilarry
midshaft- radial in the radial groove
supracondylar- median
Medial epicondyle- ulnar
In a …. neck fracture we worry about the ant and post circumflex arteries being damaged?
surgical
Where is the commonest place to fracture your clavicle?
Auction between medial 2/3 and lateral 1/3
Which muscles are responsible for the position of the classic fragments and humorous after a typical clavicle fracture?
Sternocleidomastoid pulls the medial fragment up
The wight of the lower limb pulls the lateral 1/3 down
Pectorals major internally rates the upper limb
What is a Klumke palsy?
Bottom of brachial plexus injurry through hyper-abduction of the shoulder- C8 and T1 injured- claw hand lost all intrinsics hand muscles
What is a waiters tip posture?
Damage to the superior parts of the brachial plexus- hyper extension of the neck
Arm medially rotated, whist flexed and arm adducted
Which nerves do we worry about at which positions in humerus damage?
Surgical neck- axillary
Midshaft- radial
Supracondylar- median
Medial epicondyle- ulnar
Which direction do distal fragments move in a smiths fracture?
palmar movement
If the radius fractures and the distal fragment moves dorsally its called a ? fracture
Colle’s
Damage to the long thoracic nerve results in what?
Serratus anterior palsy- winging of the scapula
What are the signs of an axillary nerve injury?
deltoid atrophy and loss of arm abduction
Hollow inferior to acromian
regimental badge sensation lost
What is axillary clearance?
Removal of the apical lymph nodes in metastatic breast cancer to reduce chance of spread.
Ruptured long head of biceps requires what action?
The tendon detaches from the supraglenoid tubercle of scapula and is often cosmetic so no surgical treatments available
Why is triceps brachii often spared in a mid shaft humeral fracture affecting the radial nerve?
Often already supplied so only muscles distal to the injury affected
A patient presents with weakened elbow flexion and opinion, what nerve injury do you suspect?
Musculocutaneous nerve - lateral forearm senation will also be reduced
What are the borders of the cubital fossa and how do you remember the contents?
Sup- imaginary line between humeral epicondyles.
med- pronator teres
lat- brachiradialis
The median cubital vein is superficial to it and is used in venipuncture
TAN- biceps tendon, branchial artery, median nerve
Name the borders of the anatomical snuff box
Extensor pollisuc longus- medial
abductor pollicus longus and extensor pollicus brevis - lateral
What is lateral epicondylitis?
Inflammation of the common extensor tendon - tennis elbow
Why do olecranon factors often need surgery?
Triceps brachii pulls fragment up and seaplanes the fracture.
The okay sign is used to check fucntion of which nerve?
Median
Where is the median nerve prone to harm?
Elbow
What 4 places may the ulnar nerve be damaged?
Post to med epicondyle
Cubital tunnel
Wrist
Hand
What is the ulnar paradox?
Ulnar claw exist when you ask a patient to make a high five hand.
If ulnar N is damaged at the elbow you damage innervation to FDP- which makes the claw look less bad.
If the nerve is damaged at the first FDP has already been supplied and thus looks worse
Cubital tunnel syndrome gives paralysis where?
Medial half of palm and medial 1.5 digits
What is duputrens contracture?
Palmer fascia thickens, fibrosis and contracts, pulling the 4th and 5th metacarpals toward the palm.
What is tendosynovitis?
Infection of synovial sheaths on the digits.
What happens in carpel tunnel?
Median nerve compresed as it enters the hand.
This can be through the tunnel getting smaller or the tendons with in swelling up and taking up more space.
What wrist injury may injure the median nerve at the wrist and what muscles will be paralysed?
Self harm Lumbrical (lateral 2) Oponins pollicus Abductor pollicus brevis Flexor pollisus brevis
What is ulnar canal syndrome?
Compression of the ulnar nerve in Guyons tunnel at the wrist
What is nurse maids elbow?
subluxation of the radial head through the annular ligament
What gives a painful arc?
degenerative tendonitis
humeral head pinches of coracoacromial arch.
Which way would the humerus dislocate in a seizure?
posterior
Shoulder dislocation risks which nerve?
Axilary
Elbow dislocations tend to be?
posterior
