Anatomy: Clinical Correlations Of Upper Extremity

Front 1

What is a single transverse palmar (aka simian) crease associated with?

Back 1

Trisomy 21 (Down Syndrome)

Note: also in small % of general pop

**Characteristic dermatoglyphic patterns are also associated with genetic disorders Turner Syndrome & Klinefelter Syndrome

Front 2

Dupuytren's Contracture

Back 2

Fibrosis and shortening of either palmar aponeurosis or longitudinal digital bands create traction on the fibrous digital sheaths

Results in flexure deformity of the digits (usually IV-V)

*can also have nodule at palm (break up or remove surgically)

*common in Northern European men

**A condition in which there is a fixed forward curvature of one or more fingers, caused by the fibrous connection b/w finger tendons and skin of palms

Front 3

Bacterial Tenosynovitis

Back 3

Bacterial infections w/in synovial tendon sheaths caused by deep penetrating injuries (i.e. animal bite).

Digit I or V (radial or ulnar bursa) can spread rapidly into neighboring bursa and proximally into forearm;

Digit II-IV typically contained w/in affected digit.

--May lead to scarring and decreased mm so must strip out tendon (won't replace itself) causing pain later on.

Front 4

Claw-hand Deformity

Back 4

With lumbrical paralysis, inadequately opposed extrinsic flexors draw affected digit(s) into a flexed position.

*Median nerve lesion

Front 5

Ape-thumb Deformity

Back 5

Superficial lacerations over thenar eminence may sever recurrent median nerve.

This will cause loss of opposition and weakened thumb flexion & abduction.

Subsequent atrophy of thenar muscles results in ape-thumb deformity.

Front 6

Carpal Tunnel Syndrome

Back 6

Compression of Median nerve w/in rigid carpal tunnel causes numbness and tingling in later 3.5 digits and weakness of thumb mm.

--More common in females.

--May be caused by edema (e.g. with pregnancy), but repetitive flexion/extension of wrist and fingers (i.e. computer use) is most common.

Front 7

Benefits & Disadvantages of Palmar Blood Supply

Back 7

Benefits: numerous anastomotic connections b/w branches of radial & ulnar arteries provide hand with excellent collateral circulation

Disadvantage: makes it difficult to control bleeding (to obtain clear surgical field may be necessary to temporarily ligate/tie off brachial artery)

Front 8

Effects of Nerve Injuries of Hand

Back 8

1. Reduced strength for any mm they take part in & will gradually atrophy

2. If other muscles can perform these actions, they will hypertrophy in an attempt to compensate

3. There may be eventual contracture deformity resulting from shortening of unopposed antagonists

4. If cutaneous, skin sensation MAY be affected (overlapping distributions may make it so not total)

Front 9

Lateral Epicondylitis

Back 9

Aka Tennis Elbow, Elbow Tendinitis

Repetitive use injury resulting from excessive use of the superficial extensor muscles of forearm;

Results from inflammation of periosteum of lateral epicondyle (at origin of superficial extensor muscles)

Pain conveyed by the superficial radial nerve radiating inferiorly from lateral epicondyle down the posterior aspect of forearm

Front 10

Mallet Finger

Back 10

Aka Baseball Finger

Avulsion of insertion of the extensor tendon on the distal phalanx;

Results from forceful flexion of the DIP joint while the finger is being extended

Person with mallet finger can extend all of the joint of the finger except for DIP, which remains flexed.

*Tendon tears, may tear off bone (bc strong)

*Must go to hospital bc can't heal on own

Front 11

Synovial Cyst of Wrist

Back 11

Cysts of mucinous fluid called "ganglion"

Non-tender swellings that appear on the hand, most commonly on dorsal aspect of wrist

Synovial sheaths can communicate with synovial cysts

*Usually not harmful; draining won't help, don't know cause; may eventually press on other structures

Front 12

Lesions of Median Nerve will also effect?

Back 12

Cutaneous innervation to lateral palm and lateral 3.5 digits

Thenar muscles

Lumbricals 1 & 2

Front 13

Lesions of Ulnar Nerve will also effect?

Back 13

Cutaneous innervation to palmar and dorsal aspects of medial hand and 1.5 digits

Palmaris Brevis

Hypothenar Muscles

Lumbricals 3 & 4

Interossei

Adductor Pollicis

Front 14

Injury to sternoclavicular joint will most likely affect?

Back 14

Clavicle.

Ligaments of sternoclavicular joint (especially costoclavicular ligament) are exceptionally strong. Thus clavicle will generally fracture before these ligaments rupture.

Front 15

Shoulder Separation

Back 15

Dislocation of AC joint; common athletic injury.

AC dislocations can involve rupture of the AC and coracoclavicular ligaments and inferomedial dislocation of acromion.

Grade 1). Sprain of AC ligament; 2). Rupture of AC capsule; 3). Both ligament & capsule (of AC and coracoclavicular) are ruptured

Gravity pulls AC medially so clavicle overrides acromion (noticeable bump)

Front 16

Excess friction w/in intertubercular groove causes what?

Back 16

Tendon of biceps brachii to fray, leading to rupture.

Why? The tendon pierces the glenohumeral joint capsule and passes through its synovial cavity.

Front 17

Rotator Cuff Injuries

Back 17

1. Inflammation of rotator cuff tendons can result in abnormal thickening of glenohumeral joint capsule and reduced range of motion (adhesive capsulitis or "frozen shoulder")

2. Calcium deposits in rotator cuff tendons (calcific tendonitis) are common cause of shoulder pain.

Front 18

Where is the fibrous capsule of the glenohumeral joint weakest?

Back 18

Inferiorly, so inferior displacement of humeral head (subluxation if partial, dislocation if total) is common in older individuals whose rotator cuff integrity is poor.

*Anterior dislocations can occur when excessive force is applied to the abducted, extended arm, often rupturing the anterior joint capsule.

Front 19

Posterior Dislocation of Elbow Joint

Back 19

2nd most common large-joint dislocation;

Typically caused by hyperextension or a fall onto a flexed forearm and may be accompanied by rupture of the anterior capsule.

"Nurse Maid's Elbow"

"Tommy John Surgery"?

Front 20

Nursemaid's Elbow

Back 20

Inferior displacement (subluxation or dislocation) of radial head occurs most frequently in small children and is caused by lifting or pulling a child by the pronated forearm.

Reduction is achieved by firm supination of flexed forearm

Front 21

Triangular Firbrocartilage Complex (TFCC)

Back 21

The articular disc of the distal radioulnar joint and its associated ligaments (radioulnar, ulnotrigetral & ulnolunate).

Degenerative or traumatic TFCC tears are common cause of medial wrist pain

*Use-wear leads to damage of TFCC

Front 22

Colles Fracture

Back 22

Extension fracture of distal radius.

Often accompanies scaphoid fracture (most common carpal fracture) when someone falls onto an outstretched hand (FOOSH)

*Scaphoid fracture typically at bone's narrow waist

Front 23

Skier thumb

Back 23

Aka Gamekeeper Thumb (if chronic)

Fall onto an outstretched hand (FOOSH) with thumb in abduction can cause dislocation of 1st MP joint and rupture of medial (ulnar) collateral ligament.

Dislocation of MP joints II-IV is common in adults

Front 24

Dislocation of Interphalangeal Joints

Back 24

Most frequently occur at DIPs

Hyperextension in combo with axial compression ("jammed finger") causes dorsal dislocation of distal phalanx and may rupture palmar plate

Front 25

Upper Brachial Plexus Injury

aka Erb's Palsy or Erb-Duchenne Palsy

c5&6 ventral rami (superior trunk) are torn/severed

Back 25

Causes: excessive separation of neck and shoulder (i.e. thrown from horse, motorcycle accident, stretching an infant's neck during delivery)

Nerves: axillary, musculocutaneous and suprascapular nerves.

Loss of flexion, abduction and lateral rotation of arm; Loss of flexion, weakness of supination of forearm; Loss of sensation on lateral side of upper limb

Deformity usually adducted upper limb, medially rotated arm extended and pronated forearm (waiter's tip)

Front 26

Lower Brachial Plexus Injury

aka Klumpke's Palsy

c8&t1 ventral rami (inferior trunk) are torn/severed

Loss of wrist flexion and mm of intrinsic muscles of hand.

Back 26

Less common; caused by forceful upward pull of shoulder during birth or when grasping something to break a fall.

Paralysis & anesthesia from medial cutaneous nerves of arm/forearm, ulnar nerve and part of medial nerve.

"Total claw hand" due to loss of fx of all lumbricals and interossei; "Simian hand" due to atrophy of intrinsic muscles of hand; Horner's Syndrome (miosis, ptosis, hemianhydrosis) if cervical sympathetic ganglia are also injured

Front 27

Distal Ulnar Nerve Injury

Back 27

Will manifest as adduction of thumb and "ulnar claw" (hyperextension of MCP and flexion of IP joints of digits IV & V)

aka "Pope's Blessing" or "Hand of Benediction"