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Anatomy > Back and Extremities Clinicals > Flashcards

Back and Extremities Clinicals Flashcards

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1
Q

epidural venous plexus risks

A

if infection or metastasis get into plexus can spread to the brain

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2
Q

lumbar puncture location

A

@ L4 above or below SP (@ cauda equina to avoid damaging cord)

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3
Q

epidural anesthetic tactics

A

indirectly into epidural space
directly into subarachnoid
into sacral canal through hiatus

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4
Q

layers for lumbar puncture

A 
skin
muscle
interspinous ligament
dura mater
arachnoid mater
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5
Q

lumbar puncture risk

A

may nick pia mater around cauda equina

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6
Q

disc herniation mech

A

increased P on ant disc
nucleus pulposus bulges posteriorly
compresses SN of vert below

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7
Q

lumbar disc herniation

A 
herniates posteriorlaterally (due to thin posterior longitudinal lig)
herniates into lower part of intervertebral foramen
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8
Q

sciatica

A

radiating pain down posterior thigh to foot

along dermatomes L5, S1, sometimes L4

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9
Q

cervical herniation

A

intervertebral foramen are small so compress same nerve but it’s named for one below
(btwn C6 and C7 will compress SN C7)

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10
Q

cervical herniation

A

intervertebral foramen are small so compress same nerve but it’s named for one below
(btwn C6 and C7 will compress SN C7)

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11
Q

breast/pec surgery risk

A

may nick long thoracic nerve (runs superficial to muscle)

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12
Q

most common rotator cuff tear

A

supraspinatus tendon

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13
Q

lost likely shoulder dislocations

A

inferiorly (tendons of sits pass ant, sup and post) and sometimes anteriorly, pulled under coracoid process
may stretch radial or axillary n
weaken shoulder abduction

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14
Q

intrabrachial plexus trauma cause

A

upper (C5, C6) or lower (C8, T1) trunk gets stressed or compressed

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15
Q

compression of upper trunk results

A

affects proximal muscles:

lats, pec major, serratus ant, rhomboids, leevator scap are still fxnal

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16
Q

compression of lower trunk results

A

affects distal muscles

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17
Q

fracture of surgical neck of humerus complications

A

lesion axillary n. and post circumflex artery

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18
Q

why hard to paralyze pec major?

A

medial pectoral n innervates, but collateral innervation from lateral and medial cords

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19
Q

compression/lesion of upper trunk results

A

affects proximal muscles:
lats, pec major, serratus ant, rhomboids, leevator scap are still fxnal
lats dominate action

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20
Q

why hard to paralyze pec major?

A

medial pectoral n innervates, but collateral innervation from lateral and medial cords

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21
Q

fall on outstretched hand –>

A

scaphoid most common fracture
lunate most common dislocation
(both contact radius)

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22
Q

carpal tunnel syndrome

A

compression of median nevre from repetitive use/injury

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23
Q

million dollar nerve

A 
recurrent branch of median n.
innervated opponens pollicis
abductor pollicis brevis
flexor pollicis brevis
easy to lacerate in hand surgery - malpractice \$\$$
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24
Q

digital clawing

A

due to median nerve and/or ulnar nerve lesions

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25
ulnar lesion -->
weakened hand muscles | affect skin on pinky and half ring finger
26
upper limb lesions -- sensory vs motor
sensory first | possibly never motor
27
paresis (+lesion)
weakness often from ventral ramus lesion (other rami still supply term n)
28
paralysis (+lesion)
complete loss of motor fxn | terminal n lesion
29
nerves affected by upper trunk compression
rotator cuff axillary n musculocutaneous n proximal innervation of radial n
30
upper trunk compression causes
excessive stretch at neck during trauma | pulling on baby's head during delivery
31
upper trunk compression sign
Erb's paralysis
32
Erb's paralysis
waiter's tip hand position | elbow extended, wrist pronated and flexed
33
nerves affected by upper trunk compression
``` C5, C6 rotator cuff axillary n musculocutaneous n proximal innervation of radial n ```
34
Erb's paralysis
waiter's tip hand position | elbow extended, wrist pronated and flexed, shoulder extended, adducted and medially rotated
35
lower trunk compression nerves affected
C8, T1 median n ulnar n
36
lower trunk compression causes
trauma stretching the axilla, cervical rib, apical lung cancer, pulling on baby's arm during delivery
37
lower trunk compression --> sensory
sensory loss in medial hand (C8) and medial forearm (T1)
38
lower trunk compression --> muscle weakness
complete claw hand (lumbricals) ape/unopposable thumb (OAF) no finger spread (DAB)
39
most commonly lesioned n in upper limb
median nerve
40
types of distal median n lesions
1. carpal tunnel syndrome 2. latent carpal tunnel syndrome from dislocation of lunate 3. superficial laceration of recurrent branch of median n
41
types of proximal median n lesions
1. supracondylar humeral fracture | 2. anterior interosseous n compression
42
carpal tunnel syndromes Sx
altered sensation in lateral 3.5 digits (thumb thru half ring) ape thumb median clawed hand
43
superficial laceration of recurrent branch of median n Sx
no sensory loss | ape thumb
44
supracondylar humeral fracture
altered sensation in lateral 3.5 digits (thumb thru half ring) ape thumb digital clawing active preacher's hand (only ring/pinky can actively flex)
45
anterior interosseous n compression
no sensory loss | can't make an "o" w/ index/thumb
46
distal ulnar nerve lesions
fractured hook of hamate | compression in canal of Guyon
47
canal of Guyon
fibrous sheath for ulnar n and art, superficial to flexor retinaculum
48
distal ulnar nerve lesion Sx
ulnar clawed hand (passive hand of benediction - cannot extend pinky/ring) cannot ab/adduct fingers
49
test for PAD
try to pull a piece of paper from btwn pts fingers
50
test for DAB
push pts fingers together as they try to spread fingers
51
distal ulnar nerve lesion Sx
altered sensation in medial palm, medial 1.5 digits (pinky/half ring) ulnar clawed hand (passive hand of benediction - cannot extend pinky/ring) cannot ab/adduct fingers
52
test for DAB
push pts fingers together as they try to spread fingers
53
proximal ulnar n lesion Sx
altered sensation in medial palm, medial 1.5 digits (pinky/half ring) weakened flexor forearm muscles slight radial deviation @ wrist w/ flexion
54
proximal radial n lesions
compression in axilla | humeral mid-shaft fracture
55
distal radial n lesions
subluxation/dislocation of radius @ elbow
56
axilla compression sx
altered sensation in forearm/hand/snuffbox wrist drop (radial palsy) weakened triceps
57
distal radial n lesions
subluxation/dislocation of radius @ elbow
58
axilla compression (radial n lesion) sx
altered sensation in forearm/hand/snuffbox wrist drop (radial palsy) weakened triceps
59
humeral mid-shaft fracture (radial n lesion) sx
``` altered sensation in forearm/hand/snuffbox wrist drop (radial palsy) triceps FINE cannot extend thumb, MP joints may lesion deep brachial art ```
60
subluxation/dislocation of radius @ elbow (radial n lesion) sx
no sensory loss wrist drop weak MP extensors
61
subluxation/dislocation of radius @ elbow (radial n lesion) cause
if child is pulled with too much force off the ground | dislocate radius
62
subluxation/dislocation of radius @ elbow (radial n lesion) cause
if child is pulled with too much force off the ground | dislocate radius
63
axillary nerve lesion causes
surgical neck of humerus fracture
64
axillary nerve lesion sx
weakness in abduction: first 15 deg ok (from supraspinatus) lateral rotation ok may lesion post humeral circumflex art
65
Tommy John surgery
to repair a torn ulnar collateral ligamnet | commonly found in athletes (baseball pitchers)
66
saphenous vein used for
coronary bypass
67
likely muscle of injury in groin pull
adductor longus
68
likely location of broken hip
femoral neck
69
complications post hip break
avascular necrosis to head of femur since medial circumflex artery supplies neck first must get total hip replacement
70
complications post hip break
avascular necrosis to head of femur since medial circumflex artery supplies neck first must get total hip replacement
71
compression of fibular n -->
altered sensation in lateral leg and entire dorsum of foot
72
plantaris tear
from quick change in direction | very painful
73
tarsal tunnel syndrome
numbness and tingling of entire foot
74
saphenous vein used for
coronary bypass | may lead to tingling in saphenous n
75
tarsal tunnel syndrome
numbness and tingling of entire foot
76
complete obturator n lesion
weakness in hip adduction | no weakness in lateral rotation (gluteals still in tact)
77
complete obturator n lesion
weakness in hip adduction | no weakness in lateral rotation (gluteals still in tact)
78
lesion of superior gluteal n
waddling/trendelenburg gait pelvic sag to opposite side upper body leans toward the lesioned side to compensate
79
psoas abscess/neoplasm -->
compress femoral n @ inguinal canal
80
labor and delivery -->
compress obturator n in pelvis
81
compress inguinal canal -->
lateral femoral cutaneous n
82
compression of lateral femoral cutaneous nerve
altered sensation at lateral thigh
83
lesion of inferior gluteal n
gluteus maximus out | difficulty getting out of chairs, going up stairs
84
tibial n compression
weak knee flexion (true hammies) weak plantar flexion (gastroc and soleus) weak inversion (tib post out but tib ant still ok) altered sensory to post thigh/leg
85
causes of fibular n compression
compress @ neck of fibula (where its subcutaneous)
86
causes of fibular n compression
compress @ neck of fibula (where its subcutaneous) | if common fibular n pierces piriformis can be compressed (athletes)
87
lesion of fibular nerve means
both superficial and deep are out
88
superficial fibular n lesion
loss of eversion | loss of sensation in lateral leg and most of dorsum
89
deep fibular n lesion
ant compartment syndrome (foot drop)
90
anterior compartment syndrome -->
pain to lateral leg foot drop (common fibular n branches) normally found in athletes due to muscle hypertrophy
91
lateral compartment syndrom
pain around lateral malleolus fibularis muscles affected normally found in athletes due to muscle hypertrophy
92
pelvic neoplasm -->
lesion in: obturator n femoral n superior/inferior gluteal
93
hip fracture affects which n
common fibular | tibial
94
dislocation of femur -->
lesion in:
95
tibial n compression
weak knee flexion (true hammies) weak plantar flexion (gastroc and soleus) weak inversion (tib post out but tib ant still ok) can't stand on tip toes altered sensory to post thigh/leg, sole and lateral foor
96
lesion of fibular nerve means
both superficial and deep are out | common?
97
dislocation of femur -->
lesion in: common fibular n tibial n
98
severe injury from lateral knee -->
``` terrible triad: tear medial collateral lig tear meniscus (medial more likely) tear ACL don't heal readily - avascular ```
99
most sprains
stretch the lateral ligamnet (it's weaker) rolls toward stronger medial lig inversion sprains

Anatomy (9 decks)

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