Upper Limb Trauma and Applied Vascular Anatomy Flashcards
What is a bursa?
Closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body
Common and other causes of bursitis
- Common:
> Overuse
> Injury - Other:
> Infection
> Tendinitis
> Arthritis
Management of bursitis
- RICE
- Anti-inflammatory medicines
What causes subacromial bursitis?
- Supraspinatus tendinitis
- Bone spurs
What syndrome can subacromial bursitis cause?
Painful arc syndrome (30° above/below horizontal)
What is frozen shoulder, and what causes it?
- Pain in shoulder movement, limited movement
- Inflammation of the joint capsule
Types of rotator cuff injuries
- Tendinitis
- Tears
What sign indicates a biceps tendon tear?
Popeye’s sign
What causes olecranon bursitis?
Repeated trauma to bursa (eg. leaning on elbows studying)
What is medial epicondylitis?
Pain caused by damage to tendons of flexor muscles of forearm (have common origin at medial epicondylitis)
Grades of shoulder separation at the AC joint
- Grade I = non-displaced strain of AC ligament
- Grade II = tear of AC ligament
- Grade III = tear of AC and CC ligaments, clavicle displaced superiorly
In what direction is the shoulder most commonly dislocated?
Anteroinferior
What nerve can be damaged in a shoulder dislocation, and what does this cause?
- Axillary nerve
- Sensory loss in regimental badge area
Appearance of a shoulder dislocation
- Acromion prominent
- Shoulder flattened
- Humeral head prominent
- Arm slightly abducted
- Elbow flexed
- Forearm internally rotated, supported by other hand
What ligament is involved in a radial head subluxation, and what happens during this?
- Annular ligament
- Radius is partially pulled out of ligament and radial head is subluxated, annular ligament interposed between radial head and capitulum
What are the symptoms of radial head subluxation?
- Painful swelling
- Limited supination
Treatment of radial head subluxation
Closed reduction with either supination or hyper-rotation
Where is a fractured clavicle most common?
Junction of medial 2/3 + lateral 1/3
What causes a fractured clavicle?
- FOOSH
- Direct injury
How is a fractured clavicle managed?
- Sling
- Pain medication
- Physiotherapy
Locations where the humerus can fracture
- Surgical neck
- Midshaft
- Supracondylar
- Medial epicondyle
What to look for in a supracondylar fracture of the humerus
- Absence of radial pulse
- Ischaemia of hand (pale, cool)
- Severe swelling in forearm and/or elbow
- Open injury
- Neurological injury
What nerves can be damaged in each humerus fracture location?
- SN = axillary
- M = radial
- S = radial, ulnar
- ME = ulnar
Monteggia vs Galeazzi fracture
- M = ulna fracture, dislocation of radial head
- G = radius fracture, dislocation of distal radioulnar joint
What is a Colles fracture, and what causes it?
- Distal radial fracture with distal segment pushed dorsally (“dinner fork” deformity)
- Fall on extended hand
What is a Smith fracture, and what causes it?
- Distal radial fracture with distal segment pushed ventrally (“garden spade” deformity)
- Fall on flexed hand
What are risks with a Smith/Colles fracture?
- Median + ulnar nerve injury
- Compartment syndrome
8 carpal bones (proximal then distal rows, lateral to medial for each)
- She looks too pretty, try to catch her:
> Scaphoid
> Lunate
> Triquetrum
> Pisiform
> Trapezium
> Trapezoid
> Capitate
> Hammate
Symptoms of a scaphoid fracture
Swelling and tenderness around anatomical snuff box
What causes a scaphoid fracture?
FOOSH
Why is avascular necrosis of the proximal segment possible in a scaphoid fracture?
- Blood supply arrives from distal to proximal end
- Fracture cuts off this blood supply to the proximal segment
What causes Erb’s palsy?
- Birth injury
- Fall on shoulder
Which nerve roots are affected in Erb’s palsy?
C5-6
Which nerves are affected in Erb’s palsy?
- Axillary
- Musculocutaneous
- Suprascapular
Where does sensory loss occur in Erb’s palsy?
Lateral part of arm + forearm
What position is the arm in in Erb’s palsy?
“Waiter’s tip” position:
- Arm medially rotated
- Elbow extended
- Forearm pronated
- Wrist flexed
Which nerve roots are affected in Klumpke’s palsy?
C8-T1
Which nerves are affected in Klumpke’s palsy?
- Median
- Ulnar
Where does sensory loss occur in Klumpke’s palsy?
Hand over territory covered by median + ulnar nerves
What causes Klumpke’s palsy?
- Fall whilst stretching shoulder (grabbing tree when falling)
- Birth injury
What causes Saturday night palsy and which nerve does this damage?
- Compression axilla
- Radial nerve
What are the signs of Saturday night palsy?
- Wrist drop
- Loss of sensation over radial area of distribution
What causes carpel tunnel syndrome?
Entrapment of median nerve
What is Tinel’s sign, and what does it indicate?
- Tapping over ventral aspect of wrist produces paraesthesia
- Carpal tunnel syndrome
Risk factors of carpel tunnel syndrome
- Pregnancy
- Hypothyroid
- DM
- RA
Treatment of carpel tunnel syndrome
- Splinting
- Rest
- Surgical decompression
What causes Guyon’s canal syndrome?
Ulnar nerve compressed near hook of hamate (eg. from using bike handlebars)
What are the signs of Guyon’s canal syndrome?
Numbness + tingling in ring + small finger
Treatment of Guyon’s canal syndrome
- Splint
- Surgical decompression
Order of main arterial tree of the upper limb
- Subclavian artery
- Axillary artery
- Brachial artery
- Radial + ulnar arteries
- Deep + superficial palmar arches
- Digital arteries
Order of main venous tree of the upper limb
- Digital veins
- Dorsal venous network of the hand
- Basilic + cephalic veins, median vein of forearm
- Median cubital vein
- Cephalic, basilic + brachial veins
- Axillary vein
- Subclavian vein
Hard signs of vascular injury
- Active arterial bleeding
- Pulseless/ischaemia
- Expanding pulsatile haematoma
- Bruit or thrill
Soft signs of vascular injury
- Minor bleeding
- Injury in proximity to major vessel
- Small/moderate size haematoma
- Associated nerve injury
What is the modified Allen test for?
Checking overall blood supply to hand
What causes Volkmann’s ischaemic contracture?
Compartment syndrome of the flexor forearm compartment
Treatment of Volkmann’s ischaemic contracture
- Removal of cast
- Surgical decompression with fasciotomy
