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Musculoskeletal > Upper Limb Clinical Gross Anatomy Revisited > Flashcards

Upper Limb Clinical Gross Anatomy Revisited Flashcards

1
Q

Brachial Plexus Levels

A

C5-T1

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2
Q

Ulnar Nerve

A

C8-T1

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3
Q

Median Nerve

A

C5-T1

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4
Q

Radial Nerve

A

C5-T1

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5
Q

Erb-Duchene’s Palsy

A

MOI is injury to C5 and C6 nerve roots or upper trunk due ti traction placed on neck
Widening of angle of separation between head and shoulders, difficult delivery, etc
Paralysis of flexors of the arm, abductors and lateral rotators of the humerus
Waiter’s Tip

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6
Q

Waiter’s Tip Position

A

Iconic Erb-Duchenne injury
Adducted = abductors are paralyzed
Extended = elbow flexors are paralyzed
Medially Rotated = lateral rotators are paralyzed

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7
Q

Klumpke Injury

A

Injury to C8-T1 nerve roots or lower trunk of brachial plexus
Catching onself in a hanging position when falling
Paralysis of intrinsic hand muscles
Claw hand (2-5) appearance due to paralyzed muscles (interossei and lumbricals)
Provides balance between powerful extensor and flexor muscles to the fingers

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8
Q

Claw Hand 2-5

A

Appearance due to paralysis of muscles
Interossei, lumbricals
Provides balance between powerful extensor and flexor muscles of fingers

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9
Q

Klumpke in New Born

A

Produces flexion and supination of elbow, extension of wrist, hyperextension of the metacarpophalengeal joints
Flexion of interphalangeal joints with claw hand posture

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10
Q

Radial Nerve Injury

A

Deep branch of radial nerve
Injury to nerve as it exits the axilla or winds around the humerus in the spiral groove (midshaft humeral fracture)
Poor crutch placement, falling asleep with arm over back of chair
Downward dislocation of glenohumeral joint

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11
Q

Why are triceps spared by radial nerve injury in the middle of the arm?

A

Occurs because at this point the triceps are already innervated

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12
Q

Wrist Drop?

A

Radial nerve injury
Occurs because of paralysis of wrist extension
Loss of all sensation over the snuff box region
Chronic loss can cause flexion contractures in upper limb (paralysis of extensors and unopposed action of flexors) with complete loss of limb function

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13
Q

Complete Radial Nerve Lesion

A

Hand cannot be extended (dorsiflexed) because the forearm extensors are paralyzed

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14
Q

Wrist Drop Testing

A

Testing deep branch of radial nerve (when lesion is partial) by extending MP joints against resistance
When normal the tendons will become prominent on the dorsum of the hand

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15
Q

Ulnar Nerve Injury Sites

A

Can be compressed at elbow in the cubital tunnel and at wrist in Guyon’s tunnel

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16
Q

Guyon Tunnel Ulnar Nerve Damage

A

Compression at elbow
Can cause handlebar neuropathy
Ulnar canal syndrome

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17
Q

Ulnar Nerve Injury MOI

A

Cuts or falls on outstretched palms

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18
Q

Ulnar Nerve deficits if hit at elbow

A

Flexion of the hand results in radial deviation (abduction) due to paralysis of flexor carpi ulnaris
Wasting of hypothenar eminence and interosseous spaces if prolonged

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19
Q

Ulnar Claw

A

Clawing of digits 4/5
Clawing will be less severe than wrist injury to ulnar nerve
Elbow injury FDP tendons to 4/5 are nonfunctional
One of the possible “hand of benediction” causes

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20
Q

Elbow Injury Clawing

A

Will look worse than at wrist

Will not have innervation to FDP to 4/5 digits

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21
Q

Froment’s Sign

A

Loss of adduction of the thumb
Loss of adductor pollicis muscle due to ulnar injury
Pt. asked to grip piece of paper between thumb and index finger
If thumb flexion is seen this is a positive sign

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22
Q

Wrist Ulnar Claw

A

This looks worse than damage at the elbow because FDP is functional

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23
Q

Interossei/Lumbrical function

A

Able to flex the MP joints and extend the IP joints and counterbalance the strong flexors/extensors of the digits
When interossei/lumbricals act on a paralyzed digit the digit will claw because of unopposed forearm muscles (ED and FD)
Clawing opposite of normal function of muscles

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24
Q

Interossei Functions

A

Flex MP joints and extend the IP joints and counterbalance the strong flexors/extensors of the digits
Function in adduction/abdunction of the digits

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25
Q

Interossei/Lumbrical Clawing

A

Opposite of normal action

Hyperextended at MP joint and flexed at PIP and DIP joints

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26
Q

Ulnar Nerve Hand Innervation

A

Innervates medial 2 lumbricals (digit 4/5)

In this case only 4/5 claw

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27
Q

C8-T1 Nerve Injury

A

Causes Klumpke’s palsy

Can see clawing in digits 2-5

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28
Q

Tinel’s Sign

A

Percussion of nerve to replicate symptoms of nerve impingement
Can be median nerve at wrist to replicate carpal tunnel syndrome symptoms
Could do ulnar nerve at elbow to replicate cubital tunnel syndrome symptoms
Replication = positive finding indicative of impingement

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29
Q

Median Nerve Injury

A

Occurs at the forearm/wrist

Falling through glass door and cutting wrists

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30
Q

Lesion at Forearm

A

Ask pt to make a fist
Unable to flex radial digits due to paralysis of the radial forearm muscles
Thenar muscles are paralyzed
Ulnar flexors are innervated so they will not be affected

31
Q

Ape Hand

A

Paralyzed thenar muscles due to median nerve injury in the forearm
Opposition and Reposition of the thumb do not work!
Injury at elbow due to medial supracondylar humeral fracture or humeroulnar dislocation
Ulnar deviation of the wrist with wrist flexion

32
Q

Lesion at the Wrist

A

Ape Hand
Cannot Abduct thumb
Forearm flexors work so digits can be flexed

33
Q

Dupuytren’s Contracture

A 
Pathological thickening and shortening of the longitudinal bundles of the palmar aponeurosis
Draws fingers (digits 4/5) into palm to such a degree that they become useless
Can mimic an ulnar claw since it commonly affects digits 4/5
1st of 3 possible interpretations of hand of benediction
34
Q

Median Nerve

A

Runs in the medial bicipital groove
In cubital fossa runs medially to the branchial artery
Passes between two heads of pronator teres
Passes between 2 heads of flexor digitorum superficialis
Runs between FDS and FDP in midline
At wrist located between tendons of FDS and FCR

35
Q

Ulnar Nerve Course

A

Runs in the medial biceptal groove
In the distal arm pierces the medial intermuscular septum and turns posterior to the medial epicondyle of the humerus
Passes between the 2 heads of the flexor carpi ulnaris
Distal half of the forearm joins to the ulnar artery under the flexor carpi ulnaris

36
Q

Radial Nerve

A

Runs behind the humerus
Can be damaged in midshaft fracture of the humerus
Injured if hit in the middle of the arm
Midshaft humerus fracture able to spare triceps

37
Q

What could cause pain/numbness in the dorsum of the hand but no weakness?

A

Entrapment of the superficial branch of the radial nerve as it emerges from underneath the brachioradialis
Characterized by pain/numbness on the dorsum of the hand but no weakness

38
Q

Radial Tunnel Syndrome

A

Entrapment of posterior interosseous nerve (within supinator canal)
Weakness in extension at the MP joint
Weakness in thumb abduction and extension and weakness in wrist extension ECU affected
ECR and bracioradialis are sparred, no sensory defects

39
Q

Long Thoracic Nerve Injury

A

C5-C7 nerve damage
Danger during radical mastectomy
Trauma to lateral chest wall
Winged scapula

40
Q

Winged Scapula

A

Significant weakness in abducting the limb beyond 90 degrees (decreased scapular rotation component)
Loss of scapular fixation
Scapula will project posteriorly from posterior thorax in upper limb movements (winging)
Seen when pts are asked to push against wall with outstretched limbs

41
Q

NPH

A

Normal pressure hydrocephalus can cause radiculopathies

42
Q

Bicep MSR

A

C5-C6 (musculocutaneous nerve)

43
Q

Brachioradialis MSR

A

C6 radial nerve

44
Q

Triceps MSR

A

C7-C8 radial nerve

45
Q

C5 Nerve Root

A

Strength-deltoid, biceps brachii
MSR-biceps brachii
Sensory-lateral shoulder (skin over deltoid) and lateral arm

46
Q

C6 Nerve Root

A

Biceps brachii, wrist extension
MSR-brachioradialis
Sensory-lateral forearm, lateral palm including 5th digit and possibly second digit

47
Q

C7 Nerve Root

A

Strength-triceps brachii, wrist flexion
MSR-triceps brachii
Sensory-middle finger

48
Q

C8 Nerve Root

A

Strength-finger flexion
MSR-none
Sensory-5th digit and medial forearm, maybe 4th digit

49
Q

T1 Nerve root

A

Strength-finger adduction/abduction
MSR-none
Sensory-medial forearm

50
Q

L4 Nerve Root

A

Strength-tibialis anterior, quadriceps
MSR-patellar tendon
Sensory-medial leg, medial aspect of foot including medial malleolus

51
Q

L5 nerve Root

A

Strength-extensor hallucis longus, extensor digitorum longus, walking on heels
MSR-tibialis posterior
Sensory-dorsum of foot

52
Q

S1 nerve root

A

Strength-fibularis longus, walking on toes
MSR-calcaneal (achilles)
Sensory-lateral aspect of foot

53
Q

Dinner Fork Deformity

A

Colle’s fracture
Transverse fracture of distal radius with dorsal displacement of the hand
Radiographs reveal dorsal angulation of distal radial metaphysis

54
Q

Rotator Cuff Avulsion

A

Fracture of humerus
Fall on point of the shoulder
Muscles in greater tubercle pull the tubercle away from the head
Subscapularis muscle remains attached to the humerus and pulls the limb medially

55
Q

Rotator Cuff Instability

A

Necessary for glenohumeral stability
Supraspinatus is the most commonly injured rotator cuff muscle
Supraspinatus is the most commonly injured muscle
Can be torn while trying to lift too much weight or catching a heavy falling object

56
Q

Drop Arm Test

A

Ask pt. to lower arm from 90 degree abduction

Failure to lower arm in a smooth, controlled fashion or with pain suggests tear of supraspinatus tendon

57
Q

Carpal Tunnel Syndrome

A

Contains flexor tendons and median nerve
Covered by flexor retinaculum
Repeated overuse of wrist resulting in edema and inflammation of structures traversing the carpal tunnel
Pain of carpal tunnel syndrome
Parasthesis of lateral 3.5 fingers and distal portion of palm with paresis in flexion, abduction and opposition of the thumb

58
Q

Phalen’s Test

A

Dorsum of hands together, flex wrists
Backwards prayer position
Increases pressure in carpal tunnel
Decreases space in carpal tunnel to try to replicate tunnel syndrome symptoms in the pt

59
Q

Finkelstein’s Test

A

Tests for De Quervain Tendosynovitis
Place thumb under digits 2/3 in fist and ask patient to medially deviate wrist
Exacerbate pain associated with tenosynovitis of tendons around the snuff box

60
Q

De Quervain Tendosynovitis

A

Inflammation of the synovial sheath of the abductor pollicis longus and extensor pollics brevis

61
Q

AC Separation

A

Injury to AC joint

Complete separation involves rupture of AC and coracoclavicular ligaments

62
Q

Glenohumeral Dislocation

A

Stability of joint is sacrificed for mobility
Tendious and ligamentous support
Majority of dislocations occur inferiorly
Humeral head however may come to lie anterior or posteriorly

63
Q

Anterior Shoulder Dislocation

A

Tears joint capsule and detaches labrum

Results in a compression fracture of the humeral head

64
Q

Ruptured Tendon of Long Head of Biceps

A

Intracapsular portion of the tendon can become inflamed and erodes over time

65
Q

Snuff Box Borders

A

APL, EPB and EPL
Covered by extensor retinaculum
Think Brevis Sandwich!

66
Q

Snuffbox Floor

A

Radial artery—>dorsal carpal branch
Tendon of ECRL
Tendon of ECRB

67
Q

Snuffbox Roof

A

Superficial branch of radial nerve

Tributaries of cephalic vein

68
Q

Dupuytren’s Contracture

A

Pathological thickening and contraction of the palmar aponeurosis due to mechanical microtraumas
Shortening of longitudinal bundles of palmar aponeurosis
Draws fingers 4/5 into plam to such a degree that they become useless

69
Q

Tapping a Tendon Reflex Action

A

Results in stretching of the tendon and muscle

Extrafusal fibers and intrafusal fibers

70
Q

Muscle Spindle

A

Receives GSE and GSA
Stretching increases GSA axon innervation
Signal relayed to spinal cord–>fires GSE in anterior horn
GSE–>innervate skeletal muscle

71
Q

Flexor Digitorum Superficiales

A 
Innervated by median nerve C5-T1
Flexes proximal interphalangeal joints
Assists flexion of distal IP joints
MP joints
Wrist 
Forearm
72
Q

Flexor Digitorum Profundus

A

Innervated by median and ulnar nerves
Flexes distal IP joints 2-5
Assists flexion of digits 2-5 and wrist

73
Q

Avulsion Fracture of Medial Epicondyle

A

Ulnar nerve at risk
Muscle/ligament can pull out a small piece of bone
Leads to compromised flexor function
Forearm flexors originate at medial epicondyle

74
Q

Subluxation/Dislocation of Radial Head

A

Sudden yank on the arm of young child (extension or pronation)
Can tear the annular ligament resulting in partial subluxation or complete dislocation
Nurse Maid’s elbow
Babysitter’s elbow

Musculoskeletal (7 decks)

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