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MSS - MSK Exam 2 > Clinical Correlations of the Upper Limb > Flashcards

Clinical Correlations of the Upper Limb Flashcards

1
Q

dermatomes of upper limb

A

C4 - T3

cervical plexus
brachial plexus
intercostal nerve

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2
Q

GSA

A

pain fiber (exteroreceptive)

comes to dorsal root ganglia to dorsal root

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3
Q

angina pectoris

A

radiation of pain from thorax down left upper limb
-pain fibers assiciated with sympathetics T1-T4
T1 - T3 dermatomes of upper limb

visceral afferent interpretation present on skin

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4
Q

C345?

A

subdiaphragmatic irritaiton due to peritonitis, gall bladder inflammation, hepatic abscess, pleurisy, or accumulation of CO2 following laser surgery

pain at tip of shoulder
-phrenic nerve C345, supraclavicular nerve C34

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5
Q

p’eau d’orange

A

skin of orange
-dimpling of breast skin bc of tightening of suspensory ligaments

outward sign of tumor growth

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6
Q

dupuytrens contracture

A

thickening/contraction of longitudinal connective tissue bundles of palmar aponeurosis

draws fingers into palm

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7
Q

subacromial/subdeltoid bursitis

A

inflammation accompanied by pain and swelling within confined synovial space

-bursa surrounding glenohumeral or shoulder joint

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8
Q

olecranon bursitis

A

same as subacromial but in elbow

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9
Q

ganglion cyst

A

same as dupuytren for thendon sheaths of extensor surface of wrist

synovial inflammation

under extensor retinaculum

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10
Q

dequervains disease

A

inflammation of synovial sheath surrounding extensor pollicis brevis and abductor pollicis longus tendons

lots of trouble using thumb**

tenosynovitis - inflammation of tendon and synovial

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11
Q

trigger finger

A

same as olecranon bursitis but for flexor tendon sheaths in hand

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12
Q

axilla pathology?

A

stretching of cords of brachial plexus

  • humeral dislocation
  • tumor (pancoast or lymphoma)

compression of axillary artery
-stop bleeding distally, location of neoplastic lymph nodes toe to breast carcinoma metastasis

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13
Q

cubital fossa contents?

A

biceps tendon, brachial artery, median nerve

-lateral to medial

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14
Q

pathology of cubital fossa?

A

care during venapuncture

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15
Q

carpal tunnel

A

bound by flexor retinaculum

has 9 tendons and 1 nerve

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16
Q

carpal tunnel syndrome

A

irritation and inflammation in carpal fluid

-lots of pressure on median nerve

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17
Q

radial bursa

A

flexor pollicis longus sheath

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18
Q

ulnar bursa

A

common flexor

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19
Q

palmar aponeurosis

A

different septa branch down to carpal bone to define the compartments

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20
Q

midpalmar and thenar space

A

between the top compartments of hand and the adductor-interosseous compartment

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21
Q

clavicle

A

last bone to completely ossify
-strut for all of shoulder

used in autopsy to determine age

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22
Q

most commonly broken bond in body?

A

clavicle

-will often greenstick

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23
Q

medial clavicular dislocation

A

pressure on carotid sheath

  • vagus nerve damage also possible
  • stimulation can result in decrease in heart rate and contractility (heart PS innervation)
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24
Q

AC separation?

A

acromioclavicular separation

-strongest are conoid and trapezoid

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25
Q

grading of AC separation

A

1 - stretched AC ligaments
2 - tear AC, CC intact
3 - torn AC and CC, 3-5x increase in coracoclavicular distance
4/5 - samea s 3 with increased coracoclavicular distance
6 - complete rupture of both ligaments with inferior clavicular displacement

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26
Q

adhesive capsulitis

A

frozen shoulder

  • thickened fibrotic, inflamed and shrunken capsule
  • decreased ROM all range, ACTIVE and PASSIVE
  • arthritis, bursitis, tendonitis, inactivity, postsurgical complications

get scapular motion
-not glenohumeral

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27
Q

rotator cuff

A

traverse majority of GH capsule en rough to humeral attachments

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28
Q

what is most often injured of rotator cuff?

A

supraspinatus

torn while trying to life too much or catching a heavy falling object through repetitive overhead motion activities

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29
Q

calcific tendonitis

A

erosion and inflammation of supraspinatus via osteophyte growth in AC joint

-tendon becomes calcified (less elastic) and more brittle

30
Q

posterior glenohumeral dislocation

A

5% dislocations
posterior prominence of humeral head
-prominent coracoid process
-arm held in adduction with inability to laterally rotate humerus

31
Q

anterior glenohumeral dislocation

A

95% of dislocations
loww of normal shoulder contour

muscles pull head of humerus into axilla, humerus slightly abducted

humeral head prominent anteriorly

symptoms - paresthesia in distribution of axilalry and musculocutaneous nerves

32
Q

humero-ulnar dislocation

A

movement of ulna and radius posteriorly relative to humerus, may be associated with fractures

33
Q

radial head subluxation

A

distal movement of radial head from undercover of annular ligament of the radius

-occurs more often in children - suddenly lifted

34
Q

youth - fall on outstretched hand?

A

displacement of distal radial epiphysis

35
Q

adolescent fall on outstretched hand

A

clavicular fracture

36
Q

elderly fall on outstretched hand?

A

colle’ fracture

37
Q

colle’s fracture

A

fracture of distal radius approximately 1 inch proxmial to radiocarpal joint, prsents silver fork deformity

38
Q

most often fractured carpal bone?

A

scaphoid

-avascular necrosis

39
Q

most often dislocated carpal bone?

A

lunate bone

-can impinge on carpal tunnel

40
Q

if you put pressure on digit 3?

A

lunate dislocation

41
Q

game-keepers thumb

A

rupture of ulnar collateral ligament

-of metacarpophalangeal joint of thumb

42
Q

compression at axillary artery?

A

proximal humerus, medial surface

43
Q

compression of brachial artery?

A

medial to anterior humerus from above downward

44
Q

compression of ulnar artery?

A

distal anterior wrist lateral to pisiform

45
Q

compression of radial artery?

A

distal anterior radius, snuff box, 1st dorsal digital space

46
Q

avascular necrosis of scaphoid bone

A

non-union of distal fragment of scaphoid with proximal fragment

-distal portion contains nutrient artery entrance site and therefore, fracture may leave proximal fragment without a blood supply

47
Q

raynauds syndrome

A

increased sympathetic innervation to distal blood vessels results in increased vasoconstruction with concomitant decrease in vascular flow

fingertips are cold and limb warm proximal

danger lies in necrosis in fingers

cervicodorsla preganglionic sympathectomy can be performed

48
Q

superficial veins?

A

access for venapuncture, transfusion, catheterization

49
Q

deep veins

A

thrombosis - clot in deep vein

-trauma, fracture, deep contusion

50
Q

lymphangitis

A

inflammation of lymph vessels
-visible as red streaks

those which extend proximally from thumb and index finger follow course of cephalic vein to inferior clavicular nodes

those which originate in the medial three fingers follow the course of the basilic vein to cubital and lateral axillary lymph nodes

51
Q

lymphadenitis

A

inflammation of lymph nodes

52
Q

breast lymphatics

A

75 % lateral to nodes axillary (can palpate)

25% to parasternal nodes (deep) cannot palpate

53
Q

contralateral drainage?

A

between the breasts

54
Q

biceps tendon reflexes

A

biceps C56

55
Q

triceps tendon reflexes

A

biceps C78

56
Q

erb-duchennes palsy

A

injury to C5 C6 and nerve roots or upper trunk due to traction on neck

loss of flexors of forearm and lateral rotators of humerus

medial rotation takes over - limb held in waiters tip location

57
Q

klumpkes palsy

A

injury to C8 T1 nerve roots of lower trunk

catch in hanging position while falling

results in total claw hand
-no balance between extensor and flexor muscles (lumbrical and interossei)

58
Q

long thoracic nerve injury?

A

serratus anterior innervation
C567

results in winged scapula

  • decreased ability to fully abduct limb
  • loss of integrity of platform of upper limb from which it operates
59
Q

axillary nerve damage

A

C56

injury to nerve as it passes around quadrangular space

poor crutch placement, downward glenohumeral dislocation, fracture of surgical neck of humerus

60
Q

radial nerve damage

A

C5-T1

injury can occur as it exits axilla or winds around spiral groove

due to poor crutch placement, falling asleep with arm over back of chair, fracture of upper humerus

results in WRIST DROP

loss causes flexion contractures

61
Q

innervation of triceps?

A

happens before the radial gets to the radial groove

therefore, damage to the radial groove won’t cause decreased in triceps innervation

62
Q

musculocutaneous nerve damage?

A

C567

rarely injured
-loss of forearm flexion and supination, loss of cutaneous sensation to lateral forearm

63
Q

median nerve damage

A

C678 T1, sometimes C5

injuries at elbow due to medial supracondylar humeral fracture

results in ape hand - decreased wrist flexion, supination, thumb neutral, wasting thenar eminence

64
Q

carpal tunnel syndrome

A

inflammation impinges median nerve
-paresthesia lateral 3.5 fingers
paresis
wasting of thenar eminence

65
Q

ulnar nerve nerve

A

C8 T1

injury within canal of struthers

occurs posterior to medial humeral epicondyle
-symptoms - weakness upon flexion and adduction of wrist with paresthesia to ring and little finger

66
Q

injury in struthers canal

A

posterior to medial humeral epicondyle

67
Q

injury in guyons tunnel

A

at wrist medial to flexor retinaculum beneath pisohamate ligament

cuts or falls on outstretched palms

68
Q

major contributor to hand?

A

ulnar nerve

69
Q

ulnar claw

A

partial ulnar claw - 4 5 digits

70
Q

partial median claw

A

digits 2 and 3

71
Q

ulnar nerve lesion?

A

need to pinch

72
Q

frohments sign

A

if you pinch grab instead of adduct grab with thumb

-indicates ulnar nerve damage

MSS - MSK Exam 2 (13 decks)

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