42 terms

Anatomy Exam 1 - Clinical

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Shoulder separation
3 types; Damage to the scapula-clavicular ligament; step deformity
Shoulder Bursitis
Direction pressure of humerus on acromion; impinges subacromial space

Who: Football players
SLAP
Superior Labrum Anterior Posterior Tear; Biceps brachii long head detaches from glenoid

Cause: Twisting, repetitive rotation

Who: Softball players
Nursemaid's elbow
Radial head slips out of anular ligament; limited limb motion and held in prone position

Cause: rapid pull/jerk on pronated forearm


Kids 1-6 yo
Boxer's Fracture
5th metacarpal breaks
Rotator Cuff Tear
Supraspinatus tear;

Who: Tennis, baseball, painters

Test: Drop Arm test and Lateral raises
Clavicular Fracture
80% midshaft; Kickstand deformity (arm pulls lateral clavicle down and sternocleidomastoid pulls medial clavicle up)
Winged scapula
inability to protract medial scapula; damage to long thoracic nerve or serratus anterior

Test: Push against wall
Biceps tendon rupture
Popeye deformity after a pop or snap (distal popeye sign); most common is proximal tear of long head of biceps brachii
Supracondylar humeral fracture
Brachialis pulls proximal humerus anteriorly; triceps pulls distal humerus posteriorly

High risk damage to brachial artery, ulnar and median nerve, and growth plate
Lateral epicondylitis
Common extensor tendon; due to forceful repetitive wrist extension

Who: Tennis and painting
Medial epicondylitis
Common flexor tendon; due to repetitive gripping, squeezing

Who: Golf, racket, throwing sports
Ulnar collateral ligament reconstruction
Tommy John Surgery; torn ulnar collateral ligament

Cause: strain during repetitive pitching...baseball

Treatment: Transplant Palmaris longus
Trigger finger
inflamed nodule of flexor tendon gets trapped behind fibrous sheath

Who: rheumatoid arthritis, diabetes
DeQuervain's Tenosynovitis
Gamer's Thumb; thickening of 1st extensor compartment

repetitive thumb abduction/extension
Dupuytren's Contracture
permanent shortening of palmar aponeurosis; causes flexion
Adductor compartment stab wound
Adductor pollicis (Transverse head) commonly injured in stab victims
Compartment syndrome in forearm
usually from laceration of artery during supracondylar fractures of humerus, radius, or ulna
Volkmann's ischemic contracture
clawed appearance of hand (wrist flexion, MCP hyper extension (ext digitorum), PIP and DIP flexion)

usually from brachial artery laceration
Anastomosis of palmar arch
Allen's test
Positive if blood flows back
Negative (for anastomosis) so blood doesn't flow back via the ulna artery
Scaphoid Fracture
pain near the snuff box; radial artery is cut off = necrosis
Distal necrosis of fingers
accidental administration of intravenous drugs into artery instead of vein
Varicose veins
incompetent vein valves

Treatment: sclerotherapy
Breast Cancer
Check "sentinel" lymph nodes to see if it spread; removal of axillary lymph nodes cause lymphedema post mastectomy
Axillary nerve lesion
Weakened abduction of arm 15-90 degrees; sensory loss to lateral surface of upper arm

Cause: surgical neck fracture
Radial nerve lesion - axilla
Loss of all extensors in arm and forearm; inability to extend elbow, wrist, CMC, and MCP

Cause: compression on axilla via leaning on chair or crutch use
Radial nerve lesion - Radial groove humerus
"Wrist drop"; inability to extend wrist, CMC, MCP

Cause: Midshaft fracture
Radial nerve lesions - Distal forearm/Wrist
sensory loss in dorsal hand

Compression superficial branch via wearign tight watch
Pronator Teres Syndrome
weakened motor function and sensory parenthesia when trying to pronate;

Cause: compression of median nerve between humeral and ulnar heads of muscle from hypertrophy of pronator teres
Hand of Benediction
Patients can't flex d1-3

Caused by Median N damage at elbow or more proximal

Loss:
FPL and FDS
lateral 1/2 of FDP (d 1-2 flexion)
Lateral 2 lumbricals (L 1-2)
Thenar muscles (D 1 flexion and abuction)
Kiloh-Nevin syndrome
Ant Interosseus nerve syndrome;
Motor: Affects all deep anterior muscles
(Pronator quadratus, flexor pollicis longus, lateral 1/2 FDP)
Sensory: None

Cause: fracture of ulna or radius
Carpal Tunnel Syndrome
Median nerve damage/compression

Motor: Thenar muscles and lumbricals 1 and 2
Sensory: parenthesia of lateral palm, digits 1-3, and lateral 1/2 of digit 4; thenar wasting

Treatmetn: Endoscopic carpal tunnel release
Cubital tunnel syndrome
Motor deficits: Forearm and hand
Sensory: Medial hand and digits 4/5

Cause: compression of ulnar nerve from entrapment in cubital tunnel @ulnar groove; direct pressure, hypertrophy of forearm flexors; or tension on nerve from extended flexion of elbow
Claw hand
Ulnar damage; Froment's test (tests of pollex adduction..must flex to maintain grip on paper)

Digit 1 - loses adduction (adductor pollicis brevis)
Digit 2-3 - lose adduction and abduction (palmar and dorsal interossei mm)
Digit 4-5: Lose all flexors except FDS bc median n.
Digit 4-5 = hyperextension of MCP joint, flexion of PIP joint (bc FDS), extension of DIP joint (no FDP)

* lose of finger adduction and abduction
Handlebar palsy
Ulnar tunnel syndrome; compression of ulnar nerve on Guyon canal

Who: cyclists

parenthesia of skin on medial side and digits 4-5
Erbs-Duchenne's Palsy
Waiter's tip hand; injury to upper trunk of brachial plexus (C5-C6)

Nerves and muscles:
Axillary n, suprascapular nerve, musculocutaneous nerve, radial nerve

Actions: paralysis of abuctors, weakened lateral rotation, weakened elbow flexion and supination, weakened wrist extensors

Loss of sensation in C5-C6 dermatomes (lateral upper limb)
Klumke's palsy and claw
intrinsic muscles of hand lost (clawed)

Damage to T1 = Horner's syndrome with loss of sympathetic innervation = permanently constricted iris and droopy eyelid

Cause: Excessive upweard pull on upper limb that injures lower trunk of brachial plexus C8-T1
C5 dermatome
Lateral cubital fossa
C6 dermatome
thumb
C7 dermatome
middle finger
C8 dermatome
5th finger/pinkie
T1 dermatome
medial cubital fossa