Clinic Correlates Upper Limbs

Front 1

1. What does dermatome testing accomplish?

Back 1

Tests the integrity of ascending neuronal system.

Front 2

2. What can cause a patient to refer to pain in the tip of the shoulder and what nerves are affected?

Back 2

Subdiaphragmatic irritation due to peritonitis, gall bladder inflammation, hepatic abscess, pleurisy or accumulations of CO2 following laser surgery.

Nerves: phrenic nerve C3,4,5 & supraclavicular nerve C3,4

Front 3

3. Where is pain sensed when a patient has angina pectoris and what spinal nerves are involved?

Back 3

Pain radiates from the thorax down the left upper limb

Pain fibers associated with sympathetics from T1-T4: T1-T3 dermatomes of upper limb

Front 4

4. What is Dupuytren's contracture?

Back 4

the pathological thickening and contracture of the longitudinal connective tissue bundles of the palmar aponeurosis; draws fingers into palm to such a degree that they become useless

Front 5

5. What is tenosynovitis and what structures are involved?

Back 5

Radial and ulnar bursae; inflammation and distension with pus of synovial tendon sheaths

Front 6

6. What is significant about the clavicle?

Back 6

Most commonly broken bone int he body; due to the architecture of the shoulder joint and natural curve of the clavicle; it will often green-stick fracture in its middle third

Also used in special autopsy analysis to determine the age of badly decomposed unidentifiable remains

First bone to begin to ossify and last to completely ossify.

Front 7

7. What structures are ruptured in a complete shoulder separation?

Back 7

Rupture of acromioclavicular and coracoclavicular ligaments

Front 8

8. What is bursitis of the shoulder?

Back 8

Inflammation of subdeltoid or subacromial bursa.

Front 9

9. What muscle in the rotator cuff can tear when trying to lift too much or catching a heavy falling object?

Back 9

The supraspinatus tendon tears

Front 10

10. Falling on an outstretched hand yields different types of injuries according to age. Specify the differences

Back 10

Youth - displacement of the distal radial epiphysis

Adolescent - clavicular fracture

Elderly - Colles' fracture: fracture to the distal radius approximately 1 inch proximal to the radiocarpal joint

Front 11

11. What carpal bones are usually injured when falling on the outstretched hand?

Back 11

Scaphoid: most often fractured carpal bone

Lunate: most often dislocated carpal bone; can impinge on carpal tunnel

Front 12

12. Where are the collateral anastomoses?

Back 12

Scapular

Elbow

Hand

Front 13

13. Where are the compression sites for the different arteries located?

Back 13

Axillary artery: proximal humerus; medial surface

Brachial artery: medial to anterior humerus from above downward

Ulnar artery: distal anterior wrist lateral to pisiform

Radial artery: distal anterior radius; snuff box; first dorsal digital space

Front 14

14. What is avascular necrosis of the scaphoid bone and what can cause it?

Back 14

The non-union of distal fragment of scaphoid with proximal fragment; distal portion contains nutrient artery entrance site and therefore, fracture may leave proximal fragment without a blood suplly.

Front 15

15. What is lymphangitis and where can it occur in the upper limbs?

Back 15

Inflammation of the lymph vessels, usually visible as red streaks. Those which extend proximally from the thumb and index finger follow the course of the cephalic vein to inferior clavicular nodes. Those which originate in the medial three finger follow the course of the basilic vein to supratrochlear and lateral axillary lymph nodes.

Front 16

16. What is lymphadenitis and how is it related to lymphangitis?

Back 16

Lympadenitis: inflamed lymph nodes as a direct result of the lymphangitis.

Note: most lymph vessels from the fingers pass to the dorsum of the hand and then ascend the forearm. Therefore, infections in the fingers and plam can lead to inflammatory edema or abscess on the dorsum of the hand.

Front 17

17. What and where are the tendon reflexes in the upper body?

Back 17

Tests integrity of segmental regions of the spinal cord.

1. Biceps: C5,6

2. Triceps: C7,8

3. Brachioradialis: C6

Front 18

18. What Klumpke's palsy?

Back 18

Injury to C8,T1 nerve roots or lower trunk; due to catching one's self in a hanging position while falling or rough delivery of infant.

Loss of intrinsic muscles of the hand.

Claw hand appearance due to the loss of muscles which provide balance between the powerful extensor and flexor muscles of the fingers; i.e. lumbricals and interossei.

Front 19

19. What injury is associated with the long thoracic nerve?

Back 19

Winged Scapula

Long thoracic nerve (C5,6,7)
Decreased ability to fully abduct limb (decreased scapular rotation component)

Lost of integrity of platform of upper limb from which to operate (loss of scapular fixation)

Involves seratus anterior muscles

Front 20

20. Damage to the axillary nerve? How?

Back 20

Injury to nerve as it passes around humerus in quandrangular space.

Due to poor crutch placement, downward glenohumeral dislocation, fracture of surgical neck of humerus.

Results in the wasting of the deltoid contour, decreased abduction and flexion of the arm, loss of cutaneous sensation over lower 1/2 of deltoid

Front 21

21. What can cause injuries to the radial nerve?

Back 21

C5-T1 - Injury to the nerve as it exits the axilla or winds around the humerus in the spiral groove.

Due to poor crutch placement, falling asleep with arm over back of chair, fracture of the midshaft of the humerus, downward dislocation of glenohumeral joint.

Front 22

22. What's the difference between acute and chronic injuries to the radial nerve?

Back 22

Acute loss results in wrist drop due to the loss of innervation to all extensors and loss of sensation over snuff box region of hand.

Chronic loss results in flexion contractures of flexors in upper limb with complete loss of limb function.

Front 23

23. What about injuries involving the musculocutaneous nerve?

Back 23

C5,6,7 - Rarely injured although traumatic rupture of the brachioradialis can occur.

Loss of forearm flexion and supination; loss of cutaneous sensation to lateral forearm.

Front 24

24. Injuries to the median nerve?

Back 24

C6-T1; sometimes C5

Injuries at the elbow due to medial supracondylar humeral fracture or humeroulnar dislocation results in:

1) ape hand appearance
2) carpal tunnel syndrome

Front 25

25. What is the ape hand deformity associated with the median nerve?

Back 25

"Ape hand" appearance due to decreased wrist flexion, supination of the hand (both pronators paralyzed), thumb in neutral position (laterally rotated and adducted) and wasting of the thenar eminence, ulnar deviation of wrist with wrist flexion.

Front 26

26. What is the carpal tunnel syndrome associated with injuries to the median nerve?

Back 26

Increased activity of the wrist resulting in edema and inflammation of the structures that traverse the carpal tunnel; i.e. median nerve.

Results in parasthesias of lateral 3 1/2 fingers and paresis (weakness) upon flexion, abduction and opposition of the thumb and wasting of the thenar eminence (i.e. ape hand) and loss of the grasp reflex.

Note: falls on the outstretched palms can injure the recurrent branch of the median nerve.

Front 27

27. What injuries are associated with the ulnar nerve?

Back 27

Injuries occur behind the medial epicondyle (fracture/dislocation) or at the wrist anterior to the flexor retinaculum as a result of cuts or falls on the outstretched palms.

Front 28

28. What deficits can result from injuries to the ulnar nerve?

Back 28

1. Flexion of the hand results in radial deviation (abduction)

2. Wasting of the hypthenar eminence and interosseous spaces (tunneling)

3. "Ulnar claw" appearance of hand

4. Loss of adduction of the thumb (Froment's sign)