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MSK Anatomy > Upper limb injuries > Flashcards

Upper limb injuries Flashcards

1
Q

what is thoracic outlet syndrome? What 2 things can cause it? AXILLA

A
  • compression of nerves and vessels in the apex of the axilla
  • trauma
  • repetition in arm lifting
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2
Q

what does thoracic outlet syndrome present with? AXILLA

A
  • pain in affected limb (depending on severity and no. of nerves damaged)
  • tingling
  • muscle weakness and discolouration
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3
Q

what can be biopsied to test for breast cancer and why? AXILLA

A
  • axillary lymph nodes

- most of lymph from breast tissue drains here

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4
Q

what is the name for the removal of axillary lymph nodes? What can this lead to the damage of and what does this cause as a consequence? AXILLA

A
  • axillary clearance
  • damamge to long thoracic nerve which will cause a winged scapula as serratus anterior is innervated by this nerve (holds scapula against ribcage)
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5
Q

what vein connects the basillic and cephalic vein and what is it commonly used for? CUBITAL FOSSA

A
  • median cubital vein

- venepuncture

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6
Q

how is a suprachondylar fracture caused? CUBITAL FOSSA

A

-falling on a flexed elbow

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7
Q

fractures affecting blood flow into the forearm from the brachial artery causes what (specific name)? explain. CUBITAL FOSSA

A
  • volkmanns ischaemic contractures

- ischaemia resulting in flexors of forearm becoming fibrotic and short=uncontrolled flexion of wrist

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8
Q

what is carpel tunnel syndrome and what can it cause if left untreated? CARPAL TUNNEL

A
  • compression of median nerve due to thickened ligaments and tendon sheath
  • cause atrophy and weakness of thenar muscles
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9
Q

what 2 physcial examinations can be done to test for carpal tunnel syndrome? CARPAL TUNNEL

A
  • lightly touch wrist to detect pain

- flex wrist for 60 secs to detect pain

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10
Q

Tenderness in the anatomical snuffbox is caused by what? How does this most commonly occur? ANATOMICAL SNUFFBOX

A
  • fracture of the scaphoid

- falling on an outstretched hand

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11
Q

Why can scaphoid fractures be an emergency? ANATOMICAL SNUFFBOX

A
  • arterial supply is distal to proximal

- fracture towards proximal end of scaphoid can cause avascuar necrosis of the bone tissue=arthritis

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12
Q

What causes a winged scapula? SCAPULA

A
  • damage to long thoracic nerve
  • loss of innervation to serratus anterior
  • can no longer hold scapula against ribcage
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13
Q

Give 3 ways of damaging the long thoracic nerve

A
  • trauma to shoulder
  • repetitive movements involving shoulder
  • inflammation of structures around the nerve
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14
Q

How can you test for a winged scapula

A

push against a wall

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15
Q

what is the most common point of fracture on the clavicle? CLAVICLE

A

junction of medial 2/3 to lateral 1/3

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16
Q

What movement occurs to lateral 1/3 of clavicle when fractured and why?

A
  • inferior and medial
  • inferior due to weight of upper limb
  • medial due to pec major
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17
Q

What movement occurs to medial 2/3 of clavicle when fractured and why?

A

-superiorly due to sternocleidomastoid

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18
Q

Upwards movement of medial 2/3 of clavicle can result in what position and why?

A
  • waiters tip position (erbs palsy)
  • damage to suprascapula nerve which supplies supra and infraspinatus which are lateral rotators
  • results in unopposed medial rotation of upper limb
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19
Q

Why can a mid shaft fracture of the humerus cause wrist drop? HUMERUS

A
  • damage to radial nerve which is tightly adhered to the radial groove
  • innervates wrist extensors in forearm and so unopposed flexion occurs
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20
Q

what type of humerus fracture can cause ischaemic volkamnns contracture?

A
  • distal humerus

- e.g. supracondylar, medial epicondyle, supraepicondylar fracture

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21
Q

what nerve in particular can be damaged by a medial epicondyle fracture and what happens as a result?

A
  • ulnar nerve

- ulna claw and loss of sensation to medial 1 and a half fingers (dorsal and ventral)

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22
Q

name the 2 fractures associated with the radius and ulna and state what happens in each case.

A

DISTAL fracture

  • colle’s fracture (distal part goes posteriorly)
  • smiths fracture (distal part goes anteriorly)
23
Q

what is a boxers fracture? METACARPALS

A
  • 5th metacarpel (little finger)
  • punching
  • neck fracture-distal part displaces posteriorly
24
Q

what is a bennets fracture? METACARPALS

A
  • 1st metacarpal base fracture

- caused by hyperabduction of thumb

25
Q

what is the common cause of accessory nerve damage?

A

-iatrogenic-medical procedures

26
Q

how can you test for accessory nerve damage?

A
  • trapezius test

- shrug shoulders

27
Q

what nerves and roots are affected in ERBs palsy? BRACHIAL PLEXUS

A

C5 and 6

-musculocutaneous, axillary, nerve to subclavius, suprascapular

28
Q

what muscles are affected in ERBs palsy?

A
  • M=all bicep muscles (BBC)
  • A=deltoid and teres minor
  • N to S=subclavius
  • S=supraspinatus and infraspinatus
29
Q

What motor functions are compromised in ERBs palsy?

A
  • supinationof forearm, flexion of shoulder

- abduction of shoulder and lateral rotation

30
Q

what sensory functions are lost in ERBs palsy?

A

lateral side of arm (axillary and musculocutaneous innervations)

31
Q

Give 2 ways ERBs palsy can occur and explain what happens to the angle between the shoulder and neck.

A
  • trauma (e.g. falling off motorbike)
  • shoulder dystocia (difficult birth)
  • angle increases
32
Q

what is the name of the position that forms during Erbs palsy?

A

waiters tip

33
Q

what causes klumpkes palsy? Give 2 examples

A
  • being pulled from the arm at birth

- catching a branch above when falling from a tree

34
Q

what brachial plexus roots are affected in klumpkes palsy?

A

C8 and T1

35
Q

Mainly what nerve is affected in klumpkes palsy?

A

ulna nerve

36
Q

what muscles are affected in klumpkes palsy and what is the presenting feature?

A
  • intrinsic muscles of the hand
  • some of forearm
  • claw like hand
37
Q

describe the motor and sensory implications of axillary nerve damage

A

motor-no abduction due to lack of innervation to deltoid and teres minor
sensory-loss of sensation over regimental badge area

38
Q

With long standing axillary nerve damage, what can be palpated due to deltoid atrophy?

A

greater tuberosity of humerus

39
Q

How can the musculocutaneous nerve be injured?

A

stab wound to axilla region

40
Q

what motor functions are affected with a musculocutaneous nerve injury?

A

flexion at shoulder and elbow is weakened as well as supination

41
Q

Radial nerve damage in the axilla-motor and sensory loss?

A

yes

42
Q

Radial nerve damage in the radial groove. Does it fully damage triceps brachii? What happens in sensory innervation?

A
  • no, only partially

- only superficial branch out of 4 cutaneous nerves affected as other branches already arisen. Loss of hand innervation

43
Q

Name 2 other injuries of radial nerve besides axilla and radial groove injuries.

A
  • deep branch (motor)

- superficial branch (sensory)

44
Q

In superficial and deep branch of radial nerve injuries, how do they occur and what happens?

A

-superficial=laceration or stabbing
-deep=radial head fracture
Sensory-hand innervation lost
Motor-post forearm muscles affected, however ECRL is strong extensor and isnt affected so WRIST DROP does NOT occur

45
Q

what is the most common area of fracture at the elbow, in an ulna nerve damage?

A

-medial epicondyle

46
Q

at the elbow, damage to the ulnar nerve results in what sensory and motor loss?

A

sensory-all lost
motor-abduction occurs (due to inability to adduct using FCU), no abd or adduction of fingers (interossei), lack of movement of little and ring finger (lumbricals)

47
Q

In ulnar nerve damage at the wrist, what is the difference between sensory loss here and sensory loss when damaged at the elbow.

A

at the wrist, the dorsal branch isnt affected and so the dorsal one and a half medial fingers as well as their associated palmar areas are not affected

48
Q

what are the presenting features of the ulna claw after damage at the WRIST? why does this occur?

A

Applying to medial 2 fingers (little and ring)
-unopposed hyperextension of MCP joint and flexion of IP joint due to loss of lumbrical function-hyperextension because only the extensors in post forearm are acting and flexion at IP due to ant forearm muscles working

49
Q

Explain the ulnar paradox

A
  • expect hand to look more deformed but in actual fact, looks more normal
  • damage at the elbow
  • flexor digit profundus affected here and so flexion at distal IP joint doesnt occur-only proximal IP joint flexion occurs
50
Q

What is the presenting feature in median nerve damage at the elbow?

A

when ASKED to make a fist, patient can only flex little and ring finger

  • lateral 2 fingers cannot flex at the MCP joint due to loss of lumbrical function
  • cannot flex at the IP joints due to loss of function of ant forearm muscles
51
Q

what is acromioclavicular joint dislocation also known as?

A

separated shoulder

52
Q

what can be caused from fracture of the scaphoid? where does the tenderness arise? what will the fracture increase likelihood of?

A

avascular necrosis
anatomical snuffbox
arthritis

53
Q

what carpal bone dislocates when falling on a dorsiflexed (extended) wrist? what syndrome occurs as a result?

A
  • lunate

- moves anteriorly and compresses contents of carpal tunnel=carpal tunnel syndrome

54
Q

what 3 things occur as a result of the lunate bone dislocation?

A
  • avascular necrosis
  • parasthesia (pins and needles) of sensory distribution in median nerve area
  • weakness of thenar muscles

MSK Anatomy (10 decks)

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