Muscular Conditions

Question 1

Compartment syndrome definition, symptoms, treatment

Answer 1

Compartments limbs bound bone/ deep fascia contain muscles, nerves and blood supply.

Trauma -> haemorrhage/ oedema/ rise intra-compartmental pressure

Severe pain limb not relieved by analgesia exacerbated by passive stretch of muscles

Surgical decompression (fasciotomy)

Question 2

Compartment syndrome short and long term consequences

Answer 2

STC: increased pressure -> decreased perfusion -> ischaemic muscles releases mediators -> increase capillary permeability & pressure ->

LTC: rhambdomyolysis (muscle necrosis)/ acute kidney injury -> neurovascular signs (distal paraesthesia, then loss motor function)
-> necrotic muscle undergo fibrosis-> Volkmann’s ischaemic contracture (flexion wrist/ elbow/ interphalangeal , extension metacarpophalangeal, adduction thumb, pronation forearm)
If compartment pressure > systolic arterial pressure = loss of peripheral pulses & increased capillary refill time

Question 3

Pulled hamstring cause

Answer 3

Sudden muscular exertion, stretching posterior thigh muscles

Muscle sprain/ partial tear/ complete tear hamstring origin from ischial tuberosity, May accompanied avulsion of fragment of bone

Question 4

Winging of scapula what, cause, examination

Answer 4

Long thoracic nerve damaged supplies serratus anterior (holds scapula against ribcage) -> paralysed -> medial border protrudes posteriorly

Seen clearly: palm hand on wall push o hold unaffected shoulder hand of affected limb pull forwards

Trauma e.g. mastectomy with axiallary clearance or blunt trauma neck/ shoulder depression shoulder girdle

Question 5

Axillary lymphadenopathy 5 causes

Answer 5

Enlargement axillary LN

Infection upper limb (lymphangitis)
, red warm tender streaks visible

Infection pectoral region and breast

Metastases breast cancer

Leukaemia/ lymphoma

Metastases malignant melanoma

Question 6

Rupture biceps tendon cause, sign

Answer 6

LH rupture near scapular origin minimal trauma
>50yrs

Hear snap shoulder while lifting, flexion allow lump lowers part arm (unopposed contracted muscle belly biceps) ‘Popeye sign’

Question 7

Froment’s sign

Answer 7

Test ulnar nerve palsy, specifically paralysis adductor pollicis

Grasp paper between thumb and index finger, paper pulled away

Positive test: unable adduct thumb, instead flex thumb interphalangeal joint

Question 8

Injury musculocutaneous nerve

Answer 8

Penetrating trauma axilla, anterior dislocation of shoulder, injury surgery

Coracobrachialis, biceps, brachilais paralysed - flexion shoulder and elbow weak, supination weak, loss sensation over radial side forearm

Question 9

Palpating pulses upper limb 3

Answer 9

Brachial pulses- cubital fossa medial biceps tendon

Radial pulse- wrist, radial to prominent tendon flexor carpi radialis

Ulnar pulse- wrist, radial tendons flexor carpi ulnaris, proximal pisiform