Upper Limb Clinical Supplement Flashcards
Growth plate articulation type:
Synchondrosis (primary cartilaginous)
Sternoclavicular articulation type:
synovial saddle
Acromioclavicular articulation type:
Synovial plane/gliding
Glenoid articulation type:
Synovial ball and socket
Elbow articulation type:
Synovial hinge
Proximal radioulnar articulation type:
Synovial pivot
Distal radioulnar articulation type:
Synovial pivot
Radiocarpal articulation type:
Synovial condyloid
Intercarpal articulation type:
Synovial plane/gliding
Metacarpo-phalangeal articulation type:
Synovial condyloid
Carpometacarpal digits 2-5 articulation type:
Synovial plane/gliding
Carpometacarpal (digit 1) articulation type:
Synovial saddle
Metacarpo-phalangeal articulation type:
Synovial codyloid
Interphalangeal articulation type:
Hinge joint
Thumb dermatome
C6
Middle finger dermatome
C7
5th finger (pinkie) dermatome
C8
Medial forearm and arm dermatome
T1
C3-C5 shoulder referred pain
Things in contact with phrenic nerve;
Peritonitis
Gall bladder
Pleurisy
Hepatic absess
Pericarditis
Conoid tubercle attachment
Conoid ligament
Coracoid process attachments
Pectoralis minor
Coracobrachialis
Short head of biceps
Acromion Attachments
Deltoid and trapezius
Scapular spine attachments
Deltoid
Supraglenoid Tubercle
Long head of biceps brachii
Greater tubercle attachment
Supraspinatus
Infraspinatus
Teres Minor
Lesser tubercle attachments
Subscapularis
Transverse ligament of shoulder
Olecranon attachment
Triceps brachii
Flexor carpi ulnaris
Aconeus
Medial epicondyle attachment
Common flexor tendon
Pronator teres
Ulnar collateral ligament of elbow
Radial tuberosity attachments
Biceps brachii muscle
Dorsal Radial / Lister’s tubercle does what
Extensor pollicis longus pulley
Ulnar tuberosity attachment
Brachialis muscle
Radial styloid attachment
Tendon of brachioradialis muscle
Radial collateral ligament
Surgical neck of humerus structure at risk
Surgical neck of humerus
Posterior circumflex humeral artery
Midshaft humeral fracture at risk structures
Radial nerve, profunda brachial artery
Supracondylar humerus fracture at risk structure
Median nerve, radial nerve, ulnar nerve, brachial artery
UE Medial epincondyle fracture at risk structure
ulnar nerve
Colle’s Fx and risk
Break in radius close to wrist.
Median nerve at risk
Lunate dislocation structure at risk
Median nerve
Dupuytren’s contracture
Pathological thickening and shortening of longitudnal bundles of palmar aponeurosis.
Digits 4/5 contracted. Can mimic ulnar claw
Most commonly fractured bone in body
Clavicle
Clavicular fracture structures in danger
Suprascapular VAN
Supraclavicular nerves
Brachial plexus
Subclavian vein
Shoulder separation
Acromioclavicular joint dislocation
Involves acromioclavicular and coracoclavicular ligament rupture
Shoulder bursae locations
Subdeltoid bursa
Subacromial bursa
Rotator cuff function
Glenohumeral joint stability
Most commonly injured rotator cuff muscle
Supraspinatus
Occurs due to heavy lifting or catching falling object
Supraspinatus rupture test
Drop arm test
Ask patient to lower arm from 90deg abduction. Failure to do so smoothly suggest supraspinatus tear
Glenohumeral dislocation
Stability is sacrificed for mobility
Types and frequency of glenohumeral dislocation
Anterior 95%
Posterior 5%
Anterior glenohumeral dislocation
Anterior band of glenohumeral ligament tears and detaches labrum
Results in humeral head compression, injures axillary and radial nerves, compresses axillary artery
Long head of biceps rupture cause
Chronic inflamation causes intrascapular portion of tendon to erode and rupture
Boxers fracture
5th metacarpal
Golfers wrist
Hairline fracture of hook of hamate. Causes pain/tenderness in palm/wrist
Falls on outstreched hand by age
Youth: distal radial epiphysis broken
Adolescent: Clavicular fracture
Elderly: Colle’s fracture
Colle’s fracture sign
Dinner fork deformity
Scaphoid fracture
Often due to fall on outstretched hand
Pain in snuff box
Succeptible to avascular necrosis
Claire sucks at skateboarding
Lunate FOOSH
Most common carpal dislocation
Can impinge on carpal tunnel and median nerve
TERRIBLE TRIAD
Elbow injury:
Dislocation
Fracture of radial head
Avulsion of coronoid process
Tommy John surgery procedure + risk
Reconstruction of torn ulnar collateral ligament
Risk to ulnar nerve as it passes posterior to median epicondyle
Nursemaid’s Elbow
Yank of child’s arm tears annular ligament causing subluxation or dislocation
Pulses grading scale
0- absent
1- weak
2- normal
3- increased
4- BOUNDING
the bitch on the trauma team screaming 2+ radial pulses
Ligation of brachial artery
Greatly impaired blood flow to forearm and hand
Ligation of brachial distal artery
Collateral channels around elbow maintain circulation
Allen Test
Tests for ulnar/radial artery communication
Patient makes tight fist —> ulnar and radial arteries are compressed —> circulation should return with either artery being released.
What should be preserved in case of axillary vein laceration or compression
Cephalic vein to continue blood flow
Risk after axillary vein trauma
Air embolism
no bueno
Avascular necrosis of scaphoid mechanism
Transverese fracture causes distal and proximal fragments to be separated
Artery enters distally so proximal side may not perfuse
Lymphedema in UE is often due to iatrogenic injury of
Axillary lymph channels usually in breast or axilla surgery
Biceps MSR
C5-C6
musculocutaneous nerve
Brachioradialis MSR
C5-C6 (radial nerve)
Triceps MSR
C7-C8 (radial nerve)
Sympathetic UE innervation spinal cord levels
T2-T7
Shoulder aBduction myotome
C5-C6
Shoulder aDduction myotome
C5-T1 pec major
C5-C6 subscapularis
Shoulder flexion myotome
C5-C6
Shoulder extension myotome
C5-C8
Shoulder internal rotation myotome
C5-T1 pec major
C5-C6 subscapularis
Shoulder external rotation myotome
C5-C6
Elbox flexion myotome
C5-C6
Elbow extension myotome
C6-C8
Elbow supination myotome
C5-C7
Elbow pronation myotome
C6-C8
Wrist flexion myotome
C7-C8
Wrist extension myotome
C6
Wrist aDduction myotome
C7-C8
Finger flexion myotome
C8
Finger extension mytome
C7
Finger aBduction myotome
C8-T1
finger aDduction myotome
C8-T1
Erb’s palsy results from
C5-C6 root injury or upper trunk of brachial plexus due to neck traction
Erb’s palsy s/s
Paralysis of shoulder aBductors and lateral rotators, elbow flexors and wrist extensors
Sensory loss of C5-C6 dermatome
Waiter’s tip position = low key drug deal position
Klumkes palsy cause
Injury to C8 and T1 nerve roots or lower brachial plexus trunks… often due to falling and catching on ledge
Klumpkes palsy s/s
Claw hand digits 2-5
Neurological causes of winged scapula
Long thoracic nerve
Spinal accessory nerve
Dorsal scapular nerve
Dorsal scapular nerve injury
Due to entrapment as it passes through scalene muscle
Results in partially protracted scapula, weakness in elevation and retraction