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31 Cards in this Set
- Front
- Back
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Why won't blocking a single nerve in the anterior throacic wall produce loss of sensation?
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There is extensive terminal overlap and anastamostes in the cutaneous nerves of the thoracic wall.
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Describe the location, innervation, blood supply and lympathic drainage of the mammary gland.
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Location: Lies on deep fascia or the pectoralis major muscle from ribs II to VI and from the sternum to the midaxillary line.
Innervation: Ant and Lat cutaneous branches of 2nd to 6th intercostal nerve Blood Supply: Lateral: axillary artery, superior thoracic, thoraco-acromial, lateral thoracic and subscapular arteries Medial: branches from internal thoracic artery 2nd to 4th intercostal arteries Venous Drainage: parallel arteries, drain into axillary, internal thoracic and intercostal veins Lymphatics: 75% laterally and superiorly in axillary nodes (subclavian), remainder to parasternal nodes (bronchiomediastinal), some to intercostal nodes (thoracic duct) |
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Explain the importance of the lymphatic drainage of a cancerous mammary gland
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Vital for staging the tumor to contain nodal metestatic breast cancer.
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Peau d'Orange
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Subcutaneous lumphatic obstruction and tumor growth damage connective tissue ligaments giving an "orange peel" texture.
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Polythelia
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Third nipple possibly causing mitral valve prolapse.
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Polymastia
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Third breast. Associated with other anatomical anomalies.
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Milk Line
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Thickening of the epidermis formed as a fetus. Usually not visible.
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Cervical Rib
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Articulates with vertebra CVII.
Thoracic Outlet Syndrome are symptoms from abnormal compression of the brachial plexus. Symptoms: Tingling, pain, swelling, coldness in hand, loss of feeling in hands or arms. |
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Poland Syndrome
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Underdevlopment or absence of pectoralis muscle.
Usually show other signs as well: Abnormal gastrointestinal tract Absent pectoral muscles Brachydactyly (Short fingers)Dextrocardia Diaphragmatic hernia/defect Humerus absent/abnormal Liver/biliary tract anomalies Maternal diabetes Oligodactyly/missing fingers Radius absent/abnormal Rhizomelic micromelia (relatively shorter proximal segment of the limbs compared to the middle and the distal segments) Syndactyly of fingers (webbing) Ulna absent/abnormal Upper limb asymmetry Abnormal rib dumbness Simian crease on affected side |
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Shoulder Dislocation
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Happens easily due to flexibility of joint.
Anterio-inferior dislocation: damage to axillary artery and brachial plexus. |
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Acromioclavicular shoulder seperation
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Caused by falling on point of shoulder, usually in young men.
If enough damage is done to acromioclavicular join, the coricoclavicular join may be damage as well. Signs: Step up appearance to the shoulder with collarbone superiorly displaced. Pain moving arm medially across the body. |
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Calcific supraspinatus tendonitis
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Rotator cuff tear, usually the supraspinatus tendon below the acromion as the tendon there is likely to become calcified. Happens mostly with age with occassional sports related injuries. May be asymptomatic. The physical examination of a shoulder deals with a systematic approach constituting inspection, palpation, range of motion, strength testing, and neurological testing. The shoulder will be examined to see whether it is tender in any area or whether there is a deformity.
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Volkman's ischaemic contracture
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Permanent contracture of the hand at the wrist called "claw hand."<br />Caused by supercondylar fracture of the humerus, obstruction of brachial artery at elbow or damage to flexors in the forearm.
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Borders and contents of the cubital fossa.
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Boundaries
superior (proximal) boundary - an imaginary horizontal line connecting the medial epicondyle of the humerus to the lateral epicondyle of the humerus medial (ulnar) boundary - lateral border of pronator teres muscle lateral (radial) boundary - medial border of brachioradialis muscle deep boundary (floor)- brachialis and supinator muscles “My Bottoms Turned Red”: From medial to lateral: - Median nerve - Brachial artery - Tendon of biceps - Radial nerve |
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Radial head subluxation
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Nursemaid's elbow
Cause: longitudnal traction on arm with wrist flexed Diagnosis: pain in dorsal, distal elbow, inability to supinate arm Treatment: manipulation of ligament back into place |
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Anatomical snuffbox
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The boundaries:
Posterior: the tendon of the extensor pollicis longus. Anterior: tendon of the extensor pollicis brevis and the abductor pollicis longus. Proximal: styloid process of the radius Distal: the approximate apex of the schematic snuffbox isosceles triangle. Floor: the trapezium and scaphoid Contents: Radial artery, radial nerve, cephalic vein |
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Landmarks for radial pulse
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Styloid process of the radius.
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Palmar arch arteries
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Branch from ulnar artery dominates but radial artery contributes.
Superficial more important than deep. Supples blood to fingers on ulnar side of hand. Hypothenar syndrome: thrombosis of vessel by repeatedly using hand as a hammer. |
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Intrinsic muscles of the hand
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Intrinsic muscles of hand (palmar surface) “A OF A OF A”:
Thenar, lateral to medial: - Abductor pollicis longus - Opponens pollicis - Flexor pollicis brevis - Adductor pollicis. Hypothenar, lateral to medial: - Opponens digiti minimi - Flexor digiti minimi - Abductor digiti minimi |
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Hand muscles innervated by median nerve
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Median nerve: hand muscles innervated “The LLOAF muscles”:
- Lumbricals 1 and 2 - Opponens pollicis - Abductor pollicis brevis - Flexor pollicis brevis • To remember that these are the Median nerve muscles, think “Meat LOAF”. |
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Anterior forearm muscles - superficial group
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Anterior forearm muscles: superficial group
There are five, like five digits of your hand. Place your thumb into your palm, then lay that hand palm down on your other arm. Your 4 fingers now show distribution: spells PFPF [pass/fail, pass/fail]: Pronator teres, Flexor carpi radialis, Palmaris longus, Flexor carpi ulnaris Your thumb below your 4 fingers shows the muscle which is deep to the other four: Flexor digitorum superficialis. |
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Carpal tunnel syndrome
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Compression of the median nerve in the carpal tunnel
Diagnosis: intermittent numbness of the thumb, index, long and radial half of the ring finger, atrophy of thenar eminence and weak palm flexion |
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Allen's Test
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Allen's test is also performed prior to heart bypass surgery. The radial artery is occasionally used as a conduit for bypass surgery, and its patency lasts longer in comparison to the saphenous veins. Prior to heart bypass surgery, Allen's test is performed to assess the suitability of the radial artery to be used as a conduit. A result of less than 3 seconds is considered as good and suitable. A result of between 3-5 seconds is equivocal, whereas the radial artery will not be considered for grafting if the result is longer than 5 seconds.
The modified Allen Test 1) The hand is elevated and the patient/person is asked to make a fist for about 30 seconds. 2) Pressure is applied over the ulnar and the radial arteries so as to occlude both of them. 3) Still elevated, the hand is then opened. It should appear blanched (pallor can be observed at the finger nails). 4) Ulnar pressure is released and the color should return in 7 seconds. Inference: Ulnar artery supply to the hand is sufficient and it is safe to cannulate/prick the radial If color does not return or returns after 7–10 seconds, the test is considered negative and the ulnar artery supply to the hand is not sufficient. The radial artery therefore cannot be safely pricked/cannulated. |
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Colle's fracture
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Distal fracture of the radius in the forearm with dorsal (posterior) displacement of the wrist and hand. The fracture is sometimes referred to as a "dinner fork" or "bayonet" deformity due to the shape of the resultant forearm.
Caused by falling with arms outstretched. |
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Smith's fractures
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Sometimes known as a reverse Colles' fracture is a fracture of the distal radius. It is caused by a direct blow to the dorsal forearm or falling onto flexed wrists, as opposed to a Colles' fracture which occurs as a result of falling onto wrists in extension. Smith's fractures are less common than Colles' fractures.
The distal fracture fragment is displaced ventrally, as opposed to a Colles' fracture which the fragment is displaced dorsally. |
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Boxer's fracture
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A fracture at the neck of a metacarpal bone, whose head participates in forming the knuckles of the hand. The fracture usually occurs at the neck of the fifth metacarpal, which forms the knuckle of the little finger, but the same name may also be used for a fracture at the neck of any of the metacarpals.
Caused by punching something hard. The knuckle of the index finger tends to lead the rest of the knuckles in a hard punch, and the knuckle compresses and snaps the neck of the metacarpal bone. |
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Dupuytren's contracture
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A deformity of the hand due to thickening and fibrosis of the palmar aponeurosis and eventual contracture of the 4th and 5th digits. Eventually the metacarpal and interpherangeal joints of the 4th and 5th digits become permanently flexed. This claw appearance can be distinguished from an ulnar claw in that the metacarpal is flexed in Dupuytren’s but hyperextended in ulnar nerve injuries.
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Trigger Finger<br />"Stenosing tensynovitis"
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Catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain. A disparity in size between the flexor tendon and the surrounding retinacular pulley system, most commonly at the level of the first annular (A1) pulley, results in difficulty flexing or extending the finger and the “triggering” phenomenon.
Diagnosis is made almost exclusively by history and physical examination. More than one finger may be affected at a time, though it usually affects the thumb, middle, or ring finger. The triggering is usually more pronounced in the morning, or while gripping an object firmly. |
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Ulnar claw hand
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An abnormal hand position that develops due to a problem with the ulnar nerve. A hand in ulnar claw position will have the 4th and 5th fingers drawn towards the back of the hand at the first knuckle and curled towards the palm at the second and third knuckles.
Ulnar Nerve – Deficit is primarily in 4th and 5th fingers Deficit is most prominent at rest and when the patient is asked to extend his fingers Often accompanied by difficulty opposing the thumb. Often accompanied by apparent atrophy of the first dorsal interosseous muscle of the hand. Median Nerve – Deficit is primarily in 2nd and 3rd fingers. Deficit is most prominent when asked to make a fist. Often accompanied by inability to abduct or adduct the 2nd, 3rd, 4th and 5th finger. Often accompanied by wasting of thenar muscles. |
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Hand of benediction
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Caused by median nerve lesions. The hand will show hyper-extension of the metacarpophalangeal joints (MCP) and flexion at the Interphalangeal (IP) joints of the 2nd and 3rd digits (index and middle). The pathogenesis is similar to that of ulnar clawing (loss of the relevant lumbricals and unopposed action of forearm flexors and extensors), and a median claw hand will appear almost identical to an ulnar claw when the patient with a median claw is asked to make a fist.
The following signs may be used to distinguish median nerve clawing from ulnar nerve clawing clinically. Ulnar Nerve – Deficit is primarily in 4th and 5th fingers Deficit is most prominent at rest and when the patient is asked to extend his fingers Often accompanied by difficulty opposing the thumb. Often accompanied by apparent atrophy of the first dorsal interosseous muscle of the hand. Median Nerve – Deficit is primarily in 2nd and 3rd fingers. Deficit is most prominent when asked to make a fist. Often accompanied by inability to abduct or adduct the 2nd, 3rd, 4th and 5th finger. Often accompanied by wasting of thenar muscles. |
