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Musculoskeletal/Skin - WLB > Week 3 - Severson > Flashcards

Week 3 - Severson Flashcards

1
Q

How do fractures of the olecranon process of the elbow usually occur?

A

Fall on the elbow combined with sudden powerful contraction of the triceps brachii

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2
Q

How does a Colles’ and Smith’s fracture differ?

A
  • Colles
    • displacement of the distal radius posteriorly (dorsally)
  • Smith’s
    • a.k.a. reverse Colles
    • displacement of the distal radius anteriorly (ventrally)
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3
Q

What nerve is responsible for supplying most of the forearm flexors?

A

Median nerve

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4
Q

What forearm muscles are supplied by the ulnar nerve?

A

Flexor carpi ulnaris

&

Medial part of: Flexor digitorum profundus

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5
Q

How would the clinical manifestations of injury to the median nerve differ when it occurs in the arm or proximal forearm versus the distal forearm?

A
  • Proximal:
    • flexion of the PIP joints of the 1st-3rd digits is lost and flexion of the 4th & 5th digits is weakened
    • flexion of the DIP joints of the 2nd & 3rd digits is also lost
    • unable to make a fist, 2nd & 3rd fingers remain partially extended (“hand of benediction”)
  • Distal:
    • paresis of the flexor digitorum profundus and flexor pollicis longus occurs
    • Abnormal “ok” sign (“pinch ok”)
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6
Q

Why is the median nerve involved in pronator syndrome?

A

nerve entrapment syndrome: caused by compression of the median nerve near the elbow

(compression by pronator teres)

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7
Q

What is Volkmann’s contracture?

A

ischemic compartment syndrome

  • 6+ hours of ischemia of muscles/nerves
  • fibrous scar tissue replaces necrotic tissue
  • involved muscles shorten permanently
  • flexion deformity
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8
Q

Where is ulnar nerve injury most likely to occur?

A

where the nerve passes posterior to the medial epicondyle of the humerus

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9
Q

What muscles would be affected with ulnar nerve injury in the proximal forearm?

A

intrinsic hand muscles

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10
Q

Why is adduction (medial or ulnar deviation) of the hand difficult following ulnar nerve injury in the arm or elbow?

A

no FCU

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11
Q

How would ulnar injury differ if it occurs in the distal forearm?

A

atrophy of the interosseous muscles = claw hand

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12
Q

What is cyclist’s palsy and how does it occur?

A
  • Ulnar neuropathy, known to cyclists as handlebar palsy, is caused by compression of the ulnar nerve at the hand and wrist (medal to hypothenar eminence)
  • Causes numbness and tingling in 4th & 5th digits
  • Compression is the result of direct pressure on the ulnar nerve from the grip on the handlebars
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13
Q

What is cubital tunnel syndrome?

A

ulnar nerve entrapment in the cubital tunnel formed by the tendinous arch joining the humeral and ulnar heads of attachment of the FCU

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14
Q

Why is flexion of the distal interphalangeal (DIP) joints of the fourth and fifth digits impaired with ulnar nerve injuries?

A

flexion of the 4th & 5th DIP’s is controlled by the flexor digitorum profundus, which is innervated by the ulnar nerve

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15
Q

Why does injury to the ulnar nerve produce “clawhand” when a patient attempts to make a fist?

A

in the absence of opposition, the metacarpophalangeal joints become hyperextended, and the patient cannot flex the 4th & 5th digits at the distal interphalangeal joints when trying to make a fist

(distal lesion of the ulnar nerve)

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16
Q

What vessel is usually used to measure the pulse rate?

A

Radial artery

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17
Q

What general dysfunction is produced by injury to the radial nerve?

A

Wrist drop

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18
Q

What two muscles are involved in supinating the forearm?

A

Supinator & Biceps brachii

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19
Q

What nerve(s) innervate the two muscles that supinate the forearm?

A

Supinator: Deep branch of radial nerve

Biceps brachii: Musculocutaneous nerve

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20
Q

The tendons of what three muscles are responsible for forming the anatomical “snuffbox”?

A

Extensor pollicus longus, Abductor pollicis longus, Extensor pollicis brevis

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21
Q

What group of muscles is involved with lateral epicondylitis or “tennis elbow”?

A

Extensor tendons from the lateral epicondyle:

  • Extensor carpi radialis
  • Extensor carpi ulnaris
22
Q

What group of muscles is inolved with medial epicondylitis or “golfer’s elbow”?

A

Flexor tendons of the forearm

23
Q

Why does “wrist drop” occur with injury to the radial nerve?

A

the radial nerve innervates the extensors

when damaged, there is no opposing force to the forearm flexors

24
Q

Why is there an inability to extend the thumb and MCP joints, but not the PIP and DIP joints following injury to the radial nerve?

A

the interphalangeal joints can be extended weakly through the action of the intact lumbricals and interossei which are supplied by the median and ulnar nerves

25
Q

How do the clinical symptoms differ following severance of the radial nerve in the radial groove versus the distal arm?

A
  • Radial groove:
    • wrist drop
  • Distal arm: ?
    • inability to extend the thumb and MCP joins of the other digits
26
Q

How do the clinical symptoms differ following severance of the superfical and deep branches of the radial nerve?

A
  • Superficial:
    • coin-shaped area of anesthesia distal to the bases of the 1st & 2nd metacarpals
  • Deep:
    • inability to extend the thum and the MCP joints
27
Q

What blood vessel accompanies the radial nerve?

A

Arm: Profunda brachii artery

Forearm: Deep branch of the radial nerve is accompanied by the Posterior interosseous artery

28
Q

What are the three major joints of the forearm?

A
  1. Humero-ulnar joint (hinge type)
  2. Proximal radio-ulnar joint
  3. Humero-radial joint
29
Q

What are the three major ligaments of the forearm?

A
  • ​Radial collateral ligament
    • lateral epicondyle to radius
  • Ulnar collateral ligament
    • medial epicondyle to ulna
  • Anular ligament
    • a circular ligament holding the head of the radius to the ulna
30
Q

How does bursitis occur in the elbow region?

A

injury during falls on the elbow and infection from abrasions of the skin covering the olecranon

31
Q

What nerve may be injured with avulsion of the medial epicondyle?

A

Ulnar nerve

32
Q

What clinical symptoms would result from avulsion of the medial epicondyle?

A
  • severe abduction of the extended elbow
  • ulnar collateral ligament pulls the medial epicondyle distally
  • epiphysis for the medial epicondyle may not fuse with the distal end of the humerus
33
Q

What is a “pulled elbow”?

A

Subluxation (incomplete dislocation) of the head of the radius

34
Q

How does subluxation or dislocation of the radial head usually occur?

A

A child is suddently lifted (jerked) by the upper lim while the forearm is pronated.

35
Q

What ligament is torn in subluxation or dislocation of the radial head?

A

distal attachment of the anular ligament

36
Q

What carpal bones articulate with the distal radius?

A

Lunate & Scaphoid

37
Q

What carpal bone is most frequently fractured?

A

Scaphoid

38
Q

What bone lies in the floor of the anatomical snuffbox?

A

Scaphoid

39
Q

What blood vessel is found in the anatomical snuffbox?

A

Palmar carpal branch of the Radial artery

40
Q

What clinical complaint would you expect from the patient following fracture of this bone?

A

Pain to lateral wrist,

especially with dorsiflexion and abduction

41
Q

What bones are injured in a patient with a “boxer’s fracture”?

A

5th metacarpal

42
Q

What nerve is involved in carpal tunnel syndrome?

A

Median nerve

43
Q

What are the clinical manifestations of carpal tunnel syndrome?

A

Unable to oppose thumb

difficulty buttoning a shirt

trouble gripping things (comb)

44
Q

Why is there loss of flexion of the PIP joints of all digits with severance of the median nerve in the proximal forearm or arm?

A

the median nerve innervates the flexor digitorum superficialis, which flexes the middle phalanges at PIP joints of four digits

45
Q

Why is there loss of flexion of only the DIP joints of the index and middle fingers and not the ring and middle fingers with severance of the median nerve?

A

the median nerve only innervates the thenar muscles and first two (lateral) lumbricals

46
Q

Why is flexion of the MCP joints and extension of the PIP/DIP joints of the index and middle fingers affected by injuries of the median nerve in the elbow region?

A

digital branches of the median nerve supply the 1st and 2nd lumbricals

47
Q

When and where does injury to the median nerve usually occur?

A

Laceration of the wrist

  • attempted suicides
  • wrist slashing
48
Q

What is the relationship of the median nerve to the tendons of the flexor carpi radialis and the palmaris longus?

A

Medial to FCR

Deep to Palmaris longus

49
Q

What clinical signs with respect to the median nerve may one expect with pronator syndrome?

A
  • pain and tenderness in the proximal aspect of the anterior forearm
  • hypesthesia (decreased sensation) of palmar aspects of the radial three and half digits and adjacent palm
50
Q

What is a “ganglion”?

A

swelling or knot

non-tender cystic swelling on the dorsum of the wrist

(often from carpal tunnel syndrome)

51
Q

What is meant by “hand of benediction”?

A

partially extended 2nd and 3rd MCP joints when trying to make a fist (inability to flex digits 2/3 into a compact fist)

(occurs in median nerve injury near the elbow)

52
Q
A

Musculoskeletal/Skin - WLB (13 decks)

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