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Musculoskeletal > Upper Limb Clinical Gross Anatomy Revisited > Flashcards

Upper Limb Clinical Gross Anatomy Revisited Flashcards

(74 cards)

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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
Interossei/Lumbrical Clawing
Opposite of normal action | Hyperextended at MP joint and flexed at PIP and DIP joints
26
Ulnar Nerve Hand Innervation
Innervates medial 2 lumbricals (digit 4/5) | In this case only 4/5 claw
27
C8-T1 Nerve Injury
Causes Klumpke's palsy | Can see clawing in digits 2-5
28
Tinel's Sign
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
29
Median Nerve Injury
Occurs at the forearm/wrist | Falling through glass door and cutting wrists
30
Lesion at Forearm
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
Ape Hand
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
Lesion at the Wrist
Ape Hand Cannot Abduct thumb Forearm flexors work so digits can be flexed
33
Dupuytren's Contracture
``` 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
Median Nerve
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
Ulnar Nerve Course
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
Radial Nerve
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
What could cause pain/numbness in the dorsum of the hand but no weakness?
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
Radial Tunnel Syndrome
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
Long Thoracic Nerve Injury
C5-C7 nerve damage Danger during radical mastectomy Trauma to lateral chest wall Winged scapula
40
Winged Scapula
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
NPH
Normal pressure hydrocephalus can cause radiculopathies
42
Bicep MSR
C5-C6 (musculocutaneous nerve)
43
Brachioradialis MSR
C6 radial nerve
44
Triceps MSR
C7-C8 radial nerve
45
C5 Nerve Root
Strength-deltoid, biceps brachii MSR-biceps brachii Sensory-lateral shoulder (skin over deltoid) and lateral arm
46
C6 Nerve Root
Biceps brachii, wrist extension MSR-brachioradialis Sensory-lateral forearm, lateral palm including 5th digit and possibly second digit
47
C7 Nerve Root
Strength-triceps brachii, wrist flexion MSR-triceps brachii Sensory-middle finger
48
C8 Nerve Root
Strength-finger flexion MSR-none Sensory-5th digit and medial forearm, maybe 4th digit
49
T1 Nerve root
Strength-finger adduction/abduction MSR-none Sensory-medial forearm
50
L4 Nerve Root
Strength-tibialis anterior, quadriceps MSR-patellar tendon Sensory-medial leg, medial aspect of foot including medial malleolus
51
L5 nerve Root
Strength-extensor hallucis longus, extensor digitorum longus, walking on heels MSR-tibialis posterior Sensory-dorsum of foot
52
S1 nerve root
Strength-fibularis longus, walking on toes MSR-calcaneal (achilles) Sensory-lateral aspect of foot
53
Dinner Fork Deformity
Colle's fracture Transverse fracture of distal radius with dorsal displacement of the hand Radiographs reveal dorsal angulation of distal radial metaphysis
54
Rotator Cuff Avulsion
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
Rotator Cuff Instability
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
Drop Arm Test
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
Carpal Tunnel Syndrome
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
Phalen's Test
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
Finkelstein's Test
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
De Quervain Tendosynovitis
Inflammation of the synovial sheath of the abductor pollicis longus and extensor pollics brevis
61
AC Separation
Injury to AC joint | Complete separation involves rupture of AC and coracoclavicular ligaments
62
Glenohumeral Dislocation
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
Anterior Shoulder Dislocation
Tears joint capsule and detaches labrum | Results in a compression fracture of the humeral head
64
Ruptured Tendon of Long Head of Biceps
Intracapsular portion of the tendon can become inflamed and erodes over time
65
Snuff Box Borders
APL, EPB and EPL Covered by extensor retinaculum Think Brevis Sandwich!
66
Snuffbox Floor
Radial artery--->dorsal carpal branch Tendon of ECRL Tendon of ECRB
67
Snuffbox Roof
Superficial branch of radial nerve | Tributaries of cephalic vein
68
Dupuytren's Contracture
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
Tapping a Tendon Reflex Action
Results in stretching of the tendon and muscle | Extrafusal fibers and intrafusal fibers
70
Muscle Spindle
Receives GSE and GSA Stretching increases GSA axon innervation Signal relayed to spinal cord-->fires GSE in anterior horn GSE-->innervate skeletal muscle
71
Flexor Digitorum Superficiales
``` Innervated by median nerve C5-T1 Flexes proximal interphalangeal joints Assists flexion of distal IP joints MP joints Wrist Forearm ```
72
Flexor Digitorum Profundus
Innervated by median and ulnar nerves Flexes distal IP joints 2-5 Assists flexion of digits 2-5 and wrist
73
Avulsion Fracture of Medial Epicondyle
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
Subluxation/Dislocation of Radial Head
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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