Clinical Anatomy Flashcards
(117 cards)
A patient comes to see you complaining of pain in their posterior forearm when lifting a glass to drink or opening a door. What test would you do to confirm the likely diagnosis?
The extended finger resistance test. Production of pain towards the elbow when you press on an extended middle finger is indicative of lateral epicondylitis…or tennis elbow.
A volleyball player went to block a shot and jammed her finger. You examine her and she cannot extend the distal joint of her finger. What does she have?
Mallet finger. This is when you rupture the DIP extensor tendon.
A skateboarder slips off his board and lands on his elbow. What muscle and bone were likely involved in him “breaking” his elbow?
A flexed triceps with the tendon pulling on the olecranon.
What symptoms might be manifested in someone with a synovial ganglion cyst in the dorsum of their hand?
That similar to carpal tunnel syndrome because cysts often form near the carpal tunnel and can compress the median nerve.
A construction worker was cut with a circular saw below his elbow. What nerves contribute to him making the sign of benediction when asked to make a fist? What other clinical sign might he have?
The median nerve was severed which supplies the PIP of digits 1-3 and the DIP/MCPs of 2 & 3. Flexion of 4 & 5 remain unaffected because these are innervated by the ulnar nerve which was apparently not injured in the accident. You would also expect to see an abnormal “pinch” sign when asked to make an “OK” sign with the index and thumb because the anterior interosseous nerve is a branch off of the median nerve and innervates the flexor digitorum profundus and flexor pollicus longus.
A football player comes to see you after a biceps curl competition with decreased sensation on the volar side of fingers 1-3. You rule out carpal tunnel syndrome first. What do you do next to figure out what’s going on?
Test pronation strength and see if you can reproduce symptoms when resistance is applied upon pronation (flexion of the pronator teres). Median nerve compression by the pronator teres near the elbow is likely causing his symptoms.
What are the four common places to injure your ulnar nerve?
1.) Posterior to the medial epicondyle 2.) In the cubital tunnel (formed by the tendinous arch connecting the humeral and ulnar heads to the flexor carpi ulnaris 3.) Wrist 4.) Hand
You are a concert pianist and suffer an injury to the distal portion of your forearm. What nerve do you pray is not injured and why?
Ulnar nerve. Injury results in atrophy of interosseous muscles and “claw hand” due to unopposed action of extensors and FDP. Adduction of the wrist is impaired. The wrist is drawn medially when attempted to flex because the FCU no longer counterbalances the FCR. MCP joints become hyperextended because flexor tone is lost and you can no longer flex fingers 4 & 5. Finally the interphalangeal joints cannot extend.
An IV drug abuser comes to your clinic complaining of pain and weakness in his hand. You think he might have injured a nerve as he cannot extend his thumb or the MCP joints of the other fingers. What nerve may have been injured as a result of IV drug abuse?
He probably hit the deep radial nerve that supplies the MCP joints via the extensor digitorum.
You do a clinical test and diagnose a patient with DeQuervian Tenosynovitis. What tendons are inflammed in this patient?
The abductor pollicus longus and extensor pollicus brevis
Why in carpal tunnel do patients normally continue to have palmar sensation?
The palmar cutaneous branch of the median nerve does not pass through the carpal tunnel.
Why do people progressively lose strength in their thumb in carpal tunnel syndrome?
The median nerve supplies the abductor pollicus brevis and opponens pollicis.
What is the flexor retinaculum released on the medial side of the wrist in carpal tunnel release procedures?
In order to avoid damage to the recurrent branch of the medial nerve which is on the lateral portion of the hand.
If a person injured their median nerve by trying to commit suicide by slitting their wrist, will they still have a functional thumb if they survive?
Partially. The abductor pollicus longus and adductor pollicus can still move the thumb because they are supplied by the ulnar nerve.
Your patient tells you they have lost sensation on the medial part of their hands after riding their bike across the country. What has caused these symptoms?
Riding for a long time with your hands extended puts pressure on the hamate hooks which compresses the ulnar nerves.
A person comes to see you after a long day of skiing complaining of minimal strength in their thumb when grabbing things and turning the key of their car. What likely happened when he was skiing?
He ruptured the collateral ligament of the 1st MCP joint. This usually is a result of hyperabduction of the MCP joint of the thumb.
After being in a car accident a patient had lacerations in her forearm. She did not lose any motor function, only sensation to the dorsum of her hand. What nerve was injured and why was motor function unimpaired?
She injured the superficial branch of the radial nerve. This branches off from the radial nerve as does the posterior interosseous nerve which supplies suppinator and extensor function to the forearm. She still has function because the posterior interosseous nerve is still functioning.
Why is a streptococcus infection in the forearm an urgent condition?
The bacteria can cause huge amounts of damage as it travels up the fascial compartments of the forearm.
Your friend fell on an outstretched hand and denotes pain in his anatomical snuffbox. What portion of this broken bone is least likely to heal well?
The proximal portion of the scaphoid. It receives blood supply distally to proximally by the distal recurrent radial artery.
What type of shoulder dislocation is a quarterback most likely to get?
Anterior. When throwing the shoulder is abducted and externally rotated. Getting hit from behind can push the head of the humerus anterio-inferiorly and dislocate the shoulder.
What elbow injury is common in kids while being swung by their parents as they walk? How is this fixed?
Subluxation and dislocation of the radial head. This occurs when the radius is pulled on while the arm is pronated and the distal annular ligament is torn. The radius is put back into place by suppinating the child’s arm while flexed at the elbow.
A person slips on ice and falls on an outstretched hand. They did not break their scaphoid. What is the most common forearm fracture?
Colles fracture. It is a complete fracture of the distal 2cm of the radius.
A patient has been having problems with flexion of his hand. What muscles would you beef up to help him with this action?
Interossei (MCP joint flexion), Flexor Digitorum Superficialis (PIP joint flexion), Flexor Digitorum Profundus (DIP joint flexion), Thenar (Thumb MCP joint flexion), and the Flexor Pollicus Longus (Thumb PIP joint flexion).
A patient has been having problems with extension of his hand. What muscles would you beef up to help him with this action?
Extensor Digitorum Communis (MPC joint extension), Interossei (PIP and DIP joint extension), Extensor Pollicus Brevis (Thumb MPC joint extension), and the Extensor Pollicus Longus (Thumb PIP joint extension).