Arm & Cubital fossa - blue boxes

Question 1

reptitivie use of superficial extensor muscles of forearm - pain felt over lateral epicondyle radiating down posterior surface of the arm

Answer 1

elbow tendinitis (tennis elbow) or lateral epicondylitis)
forceful flexion and extension of the wrist strains the attahcment o fcommon extensor tendon producing inflammation of periosteum of lateral epicondyle
may feel pain when they open door/ lift a glass

Question 2

sudden severe tension on long extensor tendon - distal interphalangal joint suddenly being forced into extreme flexion - person cant extend this joint anymore

Answer 2

mallet or baseball finger

Question 3

fracture of olecranon/ fractured elbow involves this method of injury

Answer 3

usually fall on elbow combined with sudden powerful contraction of the triceps brachii

Question 4

syndrome producing pain and paresthesia in sensory distribution of median nerve and clumsiness of finger movements

Answer 4

carpal tunnel syndrome

Question 5

synvoial cysts of wrist can form in these 2 spots commonly

Answer 5

synovial sheaths

distal attachment of ECRB tendon to base of 3rd metacarpal

Question 6

a person cant flex their 1st-3rd digit PIP and flexion of 4th & 5th digits is weakened. flexion of DIP 2nd and 3rd digits also lost. flexion of DIP of 4th & 5th not affected however .
what nerve is damaged? s/s?

Answer 6

median nerve injury!
can flex 4th and 5th at DIP because ulnar n. supplies FDP
hand of benediction! (2nd and 3rd digit metacarpophalangeal joints flexure affected because median n. supplies 1st & 2nd lumbricles leading to this)

Question 7

partial paralysis (paresis) of flexor digitorum profundus and flexor pollicis longus.
which nerve damaged? s/s? name of dysfunction?

Answer 7

anterior interossues n. injury.
make “pinch” sign instead of “ok” sign because flexion absent at IP joint of thumb and DIP joint of index finger
ANTERIOR INTEROSSEUS SYNDROME

Question 8

patient has pain and tenderness in proximal aspect of anterior forearm and hypesthesia (decreased sensation) of palmar aspects of radial three and half digits and adjacent palm.
often after repeated pronation activity
maybe feels pain when shaking hainds because pronating against resistance

Answer 8

pronator syndrome!
nerve entrapment syndrome (maybe compressed between heads of pronator teres) caused by compression of median n. near the elbow

Question 9

• inability to flex DIP joint of index finger

- inability to flex digits two and three into a compact fist

Answer 9

ulnar nerve palsy!

Question 10

where do ulnar nerve injuries usually occur

Answer 10

1) posterior to medial epicondyle of humerus (most common)
2) in cubital tunnel formed by tendinous arch connecting the humeral and ulnar heads of the FCU
3) at the wrist
4) in the hand

Question 11

numbness and tingling of medial part of palm and medial one and a half fingers due to

Answer 11

ulnar nerve injury

Question 12

any lesion of ulnar nerve superior to medial epicondyle will produce

Answer 12

parasthesia of median part of the dorsum of hand

Question 13

a person has a claw hand.

which nerve damaged and where, and why is this happening?

Answer 13

distal lesion of ulnar nerve.
atrophy of interosseous muscles of hand supplied by ulnar nerve - unopposed aciton of extensors and FDP produces claw hand

Question 14

effects of distal ulnar n. injury in terms of wrist flexion/ adduction and making a fist

Answer 14

power of wrist adduction impaired and when try to flex the wrist joint - hand drawn to lateral side by FCR (supplied by median n.) in absence of balance provided by the FCU.
person also has difficulty making fist because no oppostion, MCP joints become hyperextended or he or she cannot flex the 4th/ 5th digits at DIP when trying to make fist

Question 15

cubital tunnel syndrome occurs when

Answer 15

ulnar n. entrapped in cubital tunnel formed by teninous arch joining humeral and ulnar heads of attachment of FCU

Question 16

where is radial nerve usually injured? what are the s/s?

Answer 16

radial n. - by a fracture of the humeral shaft - injury proximal to motor branches to long and shrot extensors of wrist from the (common) radial n. so primary clinical manifestation: wrist-drop

Question 17

how would you test for deep radial n. damage

Answer 17

no sensory damage
have them extend hand at MP against resistance
should see long extensor tendons prominently on dorsum of the hand

Question 18

superficial branch of radial n. effects

Answer 18

a cutaneous nerve, but sensory loss minimal

coin-shaped area of anesthesia distal to bases of 1st & 2nd metacarpals

Question 19

what does bicipital myotactic/ biceps reflex text

Answer 19

musculocutaneous nerve

C5 & C6 spinal cord segments

Question 20

what could cause inflammation of long head of biceps tendon within intertubercular sulcus?

Answer 20

repeated microtrauma in sports involving throwing e.g. baseball and cricket or use of a racquet e.g. tennis
tight, narrow, rough intertubercular sulcus may irritate and inflame the tendon, producing tenderness and creptius (crackling sound)

Question 21

what would you feel if you dislocated tendon of long head of biceps brachii

Answer 21

sensation of popping or catching during arm rotation

Question 22

long head biceps brachii long head tendon rupture - s/s, cause, age range

Answer 22

> 35 y/o
tendon torn from attachment to supraglenoid tubercle of the scapula - snap/ pop heard
detache dmuscle belly forms ball near center of distal part of anterior aspect of arm (Popeye deformity)
results from - forceful flexion of arm against excessive resistance (weight lifting) but usually due to prolonged tendinitis weakining it
repetitive overhead motions e.g. swimmers/ baseball pitchers

Question 23

stopping bleeding through manual/ surgical control of blood flow is called

Answer 23

hemostasis

Question 24

how long can muscles and nerves tolerate ischemia?

Answer 24

6 hours

Question 25

ischemic compartment syndrome (volkmann/ ischemic contracture) - cause, effects

Answer 25

after 6 hours of ischemia - fibrous scar tissue replacing necrotic tissue, causing involved muscles to shorten permanently, producing flexion deformity
flexion of fingers and sometiems wrist leading to loss of hand power as a result of irreversible necrosis of forearm flexor muscles

Question 26

midhumeral fracture injuring radial nerve in radial groove - effects

Answer 26

fracture not likely to paralyze triceps because of high origin of nerves to two of its 3 heads

Question 27

s/s of supra-epicondylar fracture of humerus

Answer 27

shortened limb - because brachialis and triceps pull distal fragment over proximal fragment

Question 28

effects of musculocutaneous n. (cause?)

Answer 28

usually knife wound because its protected in axilla
leads to ‘paralysis of coracobrachialis, biceps and brachialis’
- weak flexion maybe at shoulder joint owing to injury affecting long head of biceps brachiii and coracobrachialis
-flexion and supination of forearm greatly weakened, but not lost (brachioradialis and supinator supplied by radial n. compensate)
- loss of senation on lateral surface of forearm supplied by lateral antebrachial cutaneous nerve (continuation of the musculocutaneous n.)

Question 29

clinical sign of radial nerve injury is

Answer 29

wrist-drop - inability to extend the wrist and fingers at MP joints
relaxed wrist partly flexed because flexors and gravity unopposed

Question 30

injury to radial n. superior to origin of its branches to triceps brachii results in

Answer 30

paralysis o ftriceps, brachioradialis, supinator and extensor muscles of wrist and fingers
- loss of sensation in its cutaneous innervation

Question 31

vein used for venipuncture and coronary angiography

Answer 31

median cubital vein

• runs diagonally from cephalic vein of forearm to basilic vein of arm
• lies directly on deep fascia, crosses bicipital aponeurosis which separates it form underlying brachial a. and median n. and provides some protection to the latter

Question 32

vein pattern in cubital fossa in approx. 20% of people

Answer 32

median antebrachial vein (median vein of the forearm) divides into median basilic v. (joins basilic v. of the arm) and median cephalic v. (joins cephalic v. of arm)

Question 33

which 2 veins for venupuncture am i likely to find in the cubital fossa

Answer 33

median cubital vein (80%) [from cephalic vein of forearm or basilic vein of arm]
median antebrachial vein (20%) [bifurcates into median cephalic and median basilic veins]