Upper Limb Clinical Correlates From Lecture Flashcards
AC Joint Separation
injury to acromioclavicular ligament and/or coracoclavicular ligament(s)
Piano key sign is seen with ___
AC joint separation
Mechanism of injury for AC joint separation
fall on shoulder or outstretched hand
Mechanism of injury for clavicle fracture
fall on outstretched hand, directly on shoulder, or high impact accident
Most common location of clavicle fracture
between lateral and middle thirds of clavicle
Breast cancer usually involves the ___ lymph nodes
axillary nodes (pectoral, subscapular, apical, central, humeral)
Breast cancer in the lower medial quadrant of the breast will drain to the ___ nodes
parasternal
Winged scapula appears with an injury to the ___ (nerve), which affects the ___ (muscle)
long thoracic nerve; serratus anterior
Long thoracic nerve injury presentation
medial border and inferior angle of scapula pull away from the posterior thoracic wall, giving the scapula the appearance of a wing
Rotator cuff subacromial impingement cause
repeated abduction and flexion of the arm (throwing, swimming)
Rotator cuff muscle most commonly affected by subacromial impingement
supraspinatus
Risk factors for rotator cuff subacromial impingement
weak rotator cuff, hooked acromion, acromioclavicular osteoarthritis
Erb Duchenne Palsy occurs with an injury to ___
C5 and C6 (superior brachial plexus)
Erb Duchenne Palsy presentation
medially rotated and adducted arm, extended forearm, hand flexed behind back (waiter’s tip)
Nerves affected by Erb Duchenne Palsy (there are 6)
- axillary
- radial
- musculocutaneous
- suprascapular
- dorsal scapular
- long thoracic
Muscles affected by erb Duchenne Palsy (there 7 + 1 general category)
- deltoid
- teres minor
- supraspinatus
- infraspinatus
- biceps brachii
- brachialis
- coracobrachialis
- forearm extensors
Klumpke’s Palsy occurs with an injury to ___
C8 and T1 (inferior brachial plexus)
Klumpke’s Palsy mechanism of injury
hanging from your arm
Nerves affected in Klumpke’s Palsy (there are 3)
- ulnar
- medial brachial cutaneous
- medial antebrachial cutaneous
Muscles affected in Klumpke’s Palsy
Muscles (and sensation) on the medial side of forearm and hand
Humeral surgical neck fracture can damage the ___ nerve and ___ artery (found in the ___ space)
axillary nerve and posterior circumflex artery; quadrangular space
Humeral surgical neck fracture presentation
inability to abduct arm, loss of sensation over lateral side of shoulder and proximal arm
Humeral spiral groove fracture can damage the ___ nerve and ___ artery (found in the ___ space)
radial nerve and deep brachial artery; lateral triangular space
Nursemaid’s Elbow is caused by ___, which causes the ___ to dislocate
a torn annular ligament; radial head
Nursemaid’s Elbow mechanism of injury
pulling a child up by the arm
How to fix Nursemaid’s Elbow
supinate the forearm and flex the elbow
Olecranon bursitis can be caused by
injury, repeated leaning on elbow, or infection
Colles’ fracture is a(n) ___ fracture of the ___
extension fracture of the radius
Colles’ fracture mechanism of injury
falling and landing on outstretched hands
A dinner fork deformity is seen with a ___ fracture
Colles’ fracture
Smith’s fracture is a(n) ___ fracture of the ___
flexion fracture of the radius
Smith’s fracture mechanism of injury
falling and landing on a flexed wrist
Why is a scaphoid fracture difficult to heal?
The radial artery comes into the wrist distal to the scaphoid bone, so the area is not very vascular –> heals slowly
Carpal Tunnel Syndrome is due to ___
median nerve compression
The ___ branch of the median nerve is unaffected in Carpal Tunnel Syndrome
palmar cutaneous branch
Carpal Tunnel Syndrome mechanism of injury
inflammation of digit flexor tendons due to repeated motion pushes on the median nerve
Carpal Tunnel Syndrome presentation
numbness, tingling on palmar surface of thumb/index and middle/lateral half of ring fingers, weakness in opposition/flexion/abduction of thumb and flexion of index and ring fingers at MP joints
Muscles affected by Carpal Tunnel Syndrome (there are 4)
- abductor pollicis brevis
- flexor pollicis brevis (superficial head)
- opponens pollicis
- lumbricals (1st and 2nd)
How to diagnose Carpal Tunnel Syndrome
Phalen’s Maneuver or Tinel’s Sign
If untreated, ___ will lead to the wasting of muscles in the thenar eminence
Carpal Tunnel Syndrome
Cubital Tunnel Syndrome is due to ___
ulnar nerve compression as it passes between the medial epicondyle and olecranon
Cubital Tunnel Syndrome presentation
numbness, tingling along 5th digit/medial side of 4th digit/hand, weakness in flexing DIPs of 4th and 5th digits and in many intrinsic muscles of the hand
Radial Nerve injury is also known as ___
Saturday Night Palsy
Radial Nerve injury causes ___
wrist drop
Tennis elbow is also known as ___
lateral epicondylitis
Lateral epicondyltis mechanism of action
excessive stretching of common extensor tendon when wrist or digits are extended or when an object is repeatedly gripped
Muscle most commonly affected by lateral epicondylitis
extensor carpi radialis brevis
Ganglion cyst
benign, usually painless swelling above joints due to out-pocketing/herniation of synovial capsule
Common ganglion cyst location
scaphoid - lunate joint
Heberden’s node is joint swelling at ___ in ___ (disease)
DIPs; osteoarthritis
Bouchard’s node is joint swelling at ___ in ___ (disease)
PIPs; osteoarthritis
Boutonniere thumb deformity is due to ___ and ___ in ___ (disease)
PIP flexion, DIP extension; rheumatoid arthritis
Ulnar deviation is seen in ___ arthritis
rheumatoid
Rheumatoid arthritis joint swelling is (hard/soft)
soft
Boutonneire (Button Hole) Deformity mechanism of injury
jamming finger, laceration, rheumatoid arthritis
Boutonniere Deformity is due to ___
tear or avulsion of central band of finger extension hood; lateral bands move ventrally to PIP axis and hyperextend DIP and flex PIP as attempts are made to straighten finger
Mallet finger is due to ___
ruptured extension tendon (where lateral band inserts onto distal phalanx)
Mallet finger presentation
unopposed flexion from flexor digitorum profundus and inability to fully extend the PIP
Persistent Median Artery can cause ___
carpal tunnel syndrome
Persistent Median Artery is often associated with ___
bifurcated median nerve
Guyon’s Tunnel Syndrome is also known as ___
Cyclist’s Palsy
Guyon’s Tunnel Syndrome is ___
compression of ulnar nerve in ulnar canal
Guyon’s Tunnel Syndrome mechanism of injury
pressure on ulnar canal, often due to extended cycling
Muscles affected by Guyon’s Tunnel Syndrome
all intrinsic hand muscles except the 4.5 innervated by the median nerve
Guyon’s Tunnel Syndrome presentation
deficits in opposition, pinching, and fine motor control
