Upper Limb II Flashcards

Question

Gartland classification

Answer 1

Used for classifying supracondylar fractures of the humerus The Gartland classification: - Type 1 is minimally displaced - Type 2 is displaced with but with an intact posterior cortex - Type 3 is completely off-ended. Type 1 can usually be managed conservatively with an above elbow cast whereas types 2 and 3 typically require surgical fixation with crossed, bi-cortical k-wires.

Answer 2

Usually caused by force from behind the ulna - Fracture of the proximal ulna - Dislocation of the radius from capitulum, anteriorly at elbow

Answer 3

Fracture of the dista radius Dislocation of ulna at distal radioulnar joint

Answer 4

The most common type of radial fracture. A fall onto an outstretched hand causing a fracture of the distal radius. The structures distal to the fracture (wrist and hand) are displaced posteriorly. It produces what is known as the ‘dinner fork deformity’.

Answer 5

A fracture caused by falling onto the back of the hand. It is the opposite of a Colles’ fracture, as the distal fragment is now placed anteriorly.

Answer 6

Fracture of the 5th metacarpal neck. It is usually caused by a clenched fist striking a hard object. The distal part of the fracture is displaced anteriorly, producing shortening of the affected finger

Answer 7

Fracture of the 1st metacarpal base, caused by forced hyperabduction of the thumb. This fracture extends into the first carpometacarpal joint leading to instability and subluxation of the joint. As a result, it often needs surgical repair.

Answer 8

2nd - 7th rib posteriorly

Answer 9

Incomplete disc in joint

Answer 10

Articular disc in joint

Answer 11

= clavicle Most commonly fractured at junction between middle and outer 1/3

Answer 12

Scaphoid - trapezium = lateral attachment Pisiform - hook of hamate = medial attachment

Answer 13

Three carpal bones - trapezium - trapezoid - capitate

Answer 14

3 metacarpals 2nd 3rd 4th

Answer 15

0-15 = supraspiantous 15 - 90 = deltoid 90 - 180 = rotation of scapule by trapezius and serratous anterior

Answer 16

Rhomboids Middle fibres of trapezius =retraction

Answer 17

Trapezius unable to hold weight of arm - patient supports arm with contralateral hand Lateral fragment depressed and drawn medially -shoulder adductors e.g. pectoralis major Fragements overlap Medial fragment: slight elevation due to action of sternocleidomastoid

Answer 18

Painful arc between 60 - 120

Answer 19

3 joints, 1 synovial cavity Hinge joint: humeroulnar at trochlear and trochlear fossa Ball-and-socket joint: humeroradial joint at capitulum and radial head Pivot joint: proximal radioulnar joint at radial notch of ulna and head of radius

Answer 20

The abductor/adductor actions of extensor digitorum and the long flexors are eliminated by placing the hand flat on a table Abduction/adduction then become the actions of the intrinsic muscles only

Answer 21

First part = pre prectoralis minor -Superior throacic artery Second part = under pectoralis minor - acromiothoracic artery - lateral thoracic artery Third part = post pectoralis minor - subscapular artery - anterior circumflex artery - posterior circumflex artery

Answer 22

Starts: Lower border of teres major Ends: Head of radius

Answer 23

The medial nerve crosses from lateral to medial at mid-humerus L --> M lemon meringue

Answer 24

Commences radial neck Overlapped by brachioradialis upper 1/2 Distal forearm: lies between brachioradialis and flexor carpi radialis where it can be palpated at the wrist. Distal to the wrist the branches given off contribute to the superficial palmar arch. Passes deep to tendons of abductor pollicis longus and extensor pollicis brevis to enter the anatomical snuffbox where it is palpable. Pierces first dorsal interosseous and adductor pollicis to contribute to deep palmar arch

Answer 25

Commences at level of neck of radius Passes deep to muscles from common flexor origin. Lies on flexor digitorum profundus, overlapped by flexor carpi ulnaris. Crossed superficially by the median nerve separated from it by the deep head of pronator teres. Distally in the forearm it becomes superficial between the tendons of flexor carpi ulnaris and flexor digitorum profundus Crosses in front of the flexor retinaculum to form the superficial palmar arch with the superficial branch of the radial artery The ulnar nerve accompanies the artery on its medial side in the distal two-thirds of the forearm and across the flexor retinaculum

Answer 26

Roots: between scalenus anterior and scalenus medius tTunks: in the posterior triangle of the neck Divisions: behind the clavicle Cords: in the axilla

Answer 27

Nerve to rhomboids Nerve to subclavius Long thoracic nerve of Bell -serratous anterior, C5, C6, C7

Answer 28

Upper trunk Suprascapular nerve - Supraspinatous - Infraspinatous

Answer 29

Lateral • Lateral pectoral Medial • Medial pectoral nerve • Medial cutaneous nerve of the arm and forearm Posterior • Thoracodorsal nerve (to latissimus dorsi) • Subscapular nerve • Axillary nerve

Answer 30

C5, C6 Posterior cord Winds around surgical neck -accompanied by cirucmflex humeral arteries Motor: deltoid, teres minot Sensation: Cutaneous branch supplying sensation to skin over deltoid (Regimental)

Answer 31

C5 - T1 Posterior cord Passes posteriorly between long head and medial head of triceps -accompanied by profuna brachii artery Lies in spiral groove Pierces lateral intermuscular septum at lower 1/3 of humerus to enter anterior compartment Lies between brachialis and brachioradialis Gives off POSTERIOR INTEROSSEOUS branch at level of lateral epicondyle --> Radial nerve continues as superficial branch to brachioradialis. Above wrist emerges posteriorly from under brachioradialis and supplies sensation by cutaneous branches to posterior aspect of radial three and a half digits. Main radial nerve supplies triceps, anconeus, brachioradialis, extensor carpi radialis longus and part of brachialis Posterior interosseous branch supplies supinator, abductor pollicis longus and all remaining extensor muscle. Cutaneous supply is to the back of the arm, the flexor and radial aspects of the dorsum of the hand.

Answer 32

Posterior interosseous branch arise sat lateral epicondyle: Abductor pollicis longus Extensor carpi radialis brevis—deep branch of radial nerve Extensor digitorum Extensor digiti minimi Extensor carpi ulnaris Supinator muscle—deep branch of radial nerve Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus Extensor indicis

Answer 33

Triceps Anconeus Brachioradialis Extensor carpi radialis longus Part of brachialis

Answer 34

C5, 6, 7. Lateral cord Pierces coracobrachialis and runs between biceps and brachialis Supplies biceps, brachialis and coracobrachialis Innervates the skin of the lateral forearm

Answer 35

Enters the forearm between the heads of pronator teres. --> At this level it gives off the anterior interosseous branch Median nerve then lies on the deep aspect of flexor digitorum superficialis Superficial at the wrist lying to the ulnar side of flexor carpi radialis in the midline Gives off palmar cutaneous branch at the wrist, which passes superficial to the flexor retinaculum and supplies the palmar skin over the thenar eminence Passes deep to the flexor retinaculum, giving a branch to the thenar muscles beyond the distal skin crease MOTOR: all muscles of the flexor aspect of the forearm (except flexor carpi ulnaris and the ulnar half of flexor digitorum profundus) AND muscles of the thenar eminence and the radial two lumbricals = LOAF Supplies sensation to the radial three and a half digits and skin of the radial side of the palm

Answer 36

C8 - T1 Medial cord Lies medial to axillary and brachial artery up to mid-humerus Pierces medial intermuscular septum --> descending on anterior surface of triceps Passes behind medial epicondyle at elbow Descends between flexor carpia ulnar and flexor digitorum profundus Lies superficial on radial side of flexor carpi ulnaris Accompanies ulnar artery in distal 2/3rds forarm - Ulnar artery lies on its RADIAL side i. e. lateral side Gives off a dorsal cutaneous branch 5 cm above the wrist, which is sensory to the dorsal aspect of the ulnar one and a half fingers. Crosses the flexor retinaculum superficially Supplies: - flexor carpi ulnaris - medial half of flexor digitorum profundus - hypothenar muscles - interossei - medial two lumbricals - adductor pollicis

Answer 37

The ulnar artery lies on the raidal side to the ulnar nerve i.e. ulnar nerve is closer to the body vs artery in anatomical position

Answer 38

= forced head and shoulder apart - forced downward traction of upper limb during delivery - fall on head forcing head away from shoulder C5 and C6 Paralysis - Deltoid - Supraspinatous - Infraspinatous - Brachialis - Biceps = arm hangs limp by side as abductors paralysed, with forearm pronated (brachialis and biceps flex and supinate paralysed) and palm facing backwards -->waiter’s tip position

Answer 39

= upper limb forced towards head - -> upward traction on uper limb e. g. breach delivery e. g. falling form tree and catching self causing severe upward traction T1 = tree 1 Intrinsice muscle of hand paralysed - --> claw han - unapposed action of long flexors and long extensors - extends extend metacarpophalangeal joints - flexors flex interphalangeal joints - -- extensors at interphalangeal joints from lumbrical and interossei lost Hence clawing occurs owing to unopposed action of the long flexors Area of numbness along inner and upper arm and forearm centred on elbow joint level +/- associated with Horner’s syndrome due to traction on sympathetic chain Wasting of small muscles of hand; ‘channels’ between metacarpals, wasting of first dorsal interosseus Similar lesions may occur with Pancoast’s tumour or a cervical rib.

Answer 40

Erb's palsy Waiters tip

Answer 41

Klumpke's palsy Claw hand

Answer 42

Damaged during fractured surgical neck of humerus --> deltoid = inability to abduction shoulder + Small patch of anaesthesia over the insertion of deltoid Regimental area

Answer 43

= wrist drop Damaged in fractures of midshaft of humerus, or compression of nerve against humerus - Saturday night palsy If solely posterior interosseous nerve damaged e.g. at raidal head, wrist extension preserved by innervation of extensor carpi longus Anaesthesia on the skin on dorsum

Answer 44

May be damaged during fractures or dislocations of radial HEAD Damage to posterior interosseous branch allows extension of the wrist --> intact extensor carpi radialis longus, which is supplied by the main radial nerve before the posterior interosseous branch is given off Small area of anaesthesia on the skin on dorsum of first web space

Answer 45

Supracondylar fracture of humer Wrist injuries / lacerations Damage at elbow: - Loss or pronation (pronator teres) - Weakness of wrist flexion (flexor carpia radialis + flexor digitorum profundus) - Loss of sensation lateral plam and radial 3 1/2 digits AND ``` Damange at wrist -Paralysis of thenar muscles -Paralysis of radial two lumbricals -Loss of sensation over radial three and a half digits. ``` Damage of the nerve at both sites causes loss of accurate opposition, and the loss of cutaneous innervation makes this a serious injury with loss of tactile response.

Answer 46

Fracture medial epicondyle Dislocation of elbow Damage at wrist - Clawing of hand similar to Kulpke's - Less clawing at 2nd and 3rd digits as median nerve supply to lumbricals intact - Sensory loss over medial 1 + 1/2 fingers Damage at the elbow results in: - similar lesion to wrist except less clawing in fourth and fifth fingers, as flexor digitorum profundus to those fingers is paralysed - flexor carpi ulnaris is paralysed, therefore a tendency to radial deviation at the wrist. Confirmation of the diagnosis is by testing for lack of sensation of the medial one and a half digits, and loss of abduction and adduction of the fingers with the hand flat on a table (excludes trick movements of long flexors and extensors)

Answer 47

Second, third and fourth fingers have synovial sheaths that close proximally at the metacarpal head. Synovial sheaths of thumb and little finger extend proximally into the palm. Synovial sheath of long flexor of the thumb extends through the palm deep to the flexor retinaculum to 2.5 cm proximal to wrist (radial bursa). Synovial sheath of fifth finger forms the ulnar bursa, which encloses all finger tendons in the palm and extends proximally deep to the flexor retinaculum for 2.5 cm above the wrist.

Answer 48

If synovial sheath of 2 - 4 becomes infection --> confined to fingers If 1st or 5th digits synovium infectiosn --> spreads to entire palm

Answer 49

Pulp space infection increases the pressure in the space This may result in arterial thrombosis and necrosis of distal phalanx with the exception of its base, which is spared because of the proximal branch.

Answer 50

May indicate PALMAR infection This is caused by the thick palmar skin being firmly bound down to the underlying palmar aponeurosis. In contrast, the skin of the dorsum of the hand is loose and fluid can readily collect deep to it. Thenar space Midpalmar space Both sites of potential infection

Answer 51

Level 1: below and later to inferolateral border of pectoralis MINOR Level 2: behind pectoralis MINOR Level 3: above the upper border of pectoralis MINOR

Answer 52

Emergences from axillary lymph node drainage

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Upper Limb II Flashcards

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