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124 Cards in this Set
- Front
- Back
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Back
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Strength of Sternoclavicular Joint?
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Extremely strong, rarely tear
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What is a shoulder separation?
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Tear at the Acromioclavicular Joint or more commonly at the coracoclavicular joint
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What is the most fractured bone?
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Clavicle
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Where does the clavicle usually break?
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Lateral 1/3, concave area
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What is the only bony attachment between the shoulder girdle and the axial skeleton?
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Sternoclavicular Joint
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What are the most common anatomical areas of complaint?
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Upper limb and Lower back strain
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What is the source of most lower back pain?
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Muscle strain of the Deep Muscles of the back
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Vertebral Column
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Kyphosis?
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Convex posterior curvature of vertebral column
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Lordosis?
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Increase in lumbar curvature
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Scoliosis?
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Non-vertical curvature
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What commonly occurs when a neck is broken?
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Crush the dens of C2 (Axis) vertebra into the spinal cord
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What prevents hyperextension of the vertebral column?
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Anterior Longitudinal Ligament
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What is the most common cause of hyperextension?
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Whiplash
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What prevents hyperflexion of the vertebral column?
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Posterior Longitudinal Ligament
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What is an intervertebral disc herniation?
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Protrusion of the Nucleus Pulposus
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Describe why Intervertebral Disc Herniation occurs posterolaterally?
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Posterolateral rupture of the IV Disc due to thin Posterior Longitudinal Ligament that covers only the center of the posterior vertebral body
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What causes Posterolateral IV disc herniation?
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Flexion, Dorsal pressure on the intervertebral disc
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Most common IV Disc Herniations? Presenting pain?
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L4/L5 or L5/S1
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What causes arthritic pain in the back?
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Zygopophyseal joints
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What is the sensory innervation to the zygopophyseal joints?
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Dorsal Rami of the Spinal Nerves
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Where is the ligamenta flava located?
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Between the lamina of the vertebral column
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How are IV discs counted?
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By the vertebral body above
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If a patient has an L3 herniated disc, what nerve is compressed?
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L4
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If a patient has an C3 herniated disc, what nerve is compressed?
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C4
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Why?
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Internal Vertebral Venous Plexus
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If someone turns their head and experiences dizziness or light-headedness, what could be the cause?
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Arteriosclerosis (Harding of Arteries)
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What acts to pressurize the subarachnoid space?
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Cerebral Spinal Fluid
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Where are lumbar punctures preformed?
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L3/L4 or L4/L5
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Why are lumbar punctures performed?
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Retrieve cerebral spinal fluid for diagnostic purposes
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What pops when performing a lumbar puncture?
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Ligamenta Flava
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What is used to determine L4 area?
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Illiac Crest
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Upper Limb
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The most common fracture of the Humerus is where?
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Surgical Neck of the Humerus
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What protects the glenohumeral joint superiorly?
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Acromion
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Describe the capsule of the glenohumeral joint?
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Loose (sacrifice stability for increased mobility)
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What stabilizes the glenohumeral joint or most joints?
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Muscles
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What do you do to test medial and lateral rotation of the Humerus?
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Have patient flex elbow, rotate toward and away from chest
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What occurs most common in a shoulder dislocation?
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Anatomical Neck dislocates from the glenoid cavity inferiorly due to lack of support (no muscle inferior to joint)
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What occurs in a rotator cuff injury?
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Wear out the Supraspinatus or subacromial bursa
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Nervous System
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When testing nerve innervation, what is important to test?
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Sensory and Motor
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What is the basic dermatome layout of the upper limb (from shoulder to hand to axilla)?
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C5, C6, C7 (middle of the hand), C8, T1
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What types of nerve fibers are found in cutaneous nerves?
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GSA, GVA, GVE
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What is very susceptible to injury in the medial aspect of arm?
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Neurovascular bundle
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If the radial nerve is injured distal to the radial groove, is there any loss in extension of the forearm?
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No
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Lymphatic System
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What part of the body does the Thoracic Duct drain?
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Entire left side and right side below the diaphragm
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What drains the rest of the body?
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Right Lymphatic Duct
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Mammary Glands
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What ligaments support the mammary glands?
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Cooper’s Ligaments
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Why is this significant in cancer detection?
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Breast cancer pulls at these ligaments causing dimpling of the breasts
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Where does most of the lymphatic drainage collect from the breast?
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Lateral Pectoral Nodes
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What can spread cancer between the breasts?
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Cutaneous lymphatics
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Axilla
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What is Thoracic Syndrome?
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Possessing a cervical rib
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What causes winged scapula?
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Laceration of the Long Thoracic Nerve
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What must a surgeon be careful to miss when performing a masectomy?
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Long Thoracic Nerve
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What arteries provide collateral circulation around the scapula?
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Dorsal Scapular Artery
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Syndromes and Nerve Lesions of the Upper Limb
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What is the common injury that occurs when a person’s neck and shoulder is severely separated?
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Erb’s (Duchanne) Palsy
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What nerves are injured?
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C5 and C6 Ventral Rami at the roots of the Brachial Plexus
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What is a common cause of this injury?
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Birth or a fall (off a horse or motorcycle)
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What Nerves are affected?
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Suprascapular N.
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What muscles are lost?
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Supraspinatus M.
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What is a person’s physical presentation of Erb’s Duchanne Palsy (Waiter’s Tip)?
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Upper limb medially rotated
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What are the main antagonists causing this presentation?
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Latissimus Dorsi
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What sensory loss would occur with Erb’s Palsy?
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Shoulder (Axillary N.)
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What occurs with the loss of the Long Thoracic Nerve?
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Winged Scapula
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What muscle is paralyzed in Winged Scapula?
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Serratus Anterior
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What is Dupuytren’s Contracture?
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Shortening, thickening, fibrosis of palmar Aponeurosis resulting in marked flexion at MP joints (mainly 4th and 5th)
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What is the common injury resulting from damage to the lower roots of the brachial plexus?
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Klumpke’s Palsy
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What nerve is most affected in Klumpke’s?
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Ulnar Nerve
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What are the presenting factors from Klumpke’s?
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Weakness in wrist flexion (FCU Muscle)
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What is the result of an injured Radial Nerve in the distal radial groove?
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Wrist Drop
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With wrist drop, what extension is still possible?
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Extension at the DIP and PIP joints due to intact lumbrical and Interosseous muscles
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What causes claw hand?
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Injury of Ulnar Nerve at the wrist
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What is the result of an injured Ulnar Nerve at the wrist?
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Thumb strongly abducted
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What decreases the amount of clawing in digits 4 and 5?
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More proximal lesion to Ulnar Nerve
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The more distal the lesion . . . . .
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The greater the clawing
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Can the patient with claw hand abduct fingers? Adduct fingers?
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No
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What results from damage to the median nerve at the wrist proximal to the flexor retinaculum?
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Ape Hand
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Hand
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During surgery of the Thenar Eminence, what should you look out for?
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Recurrent Branch of the Median Nerve
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What happens to infections of the palm?
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Forced dorsal due to tight palmar Aponeurosis, plus most venous and lymphatic drainage occur on the dorsum of the hand
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What structures in the palm increases the spread of infection?
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Ulnar and Radial Bursa
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Random
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What carpal bone is broken most often?
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Scaphoid
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Why is this of concern?
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Blood supply is distal to proximal
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Does nerve entrapment effect the muscle causing the entrapment?
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No, because the nerve innervates the muscle before passing through it
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Where can nerve entrapment occur in the arm?
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Coracobrachialis : Musculocutaneous Nerve
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What would this cause?
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No loss to Coracobrachialis action
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Where can nerve entrapment occur in the extensor compartment of the forearm?
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Supinator: Deep Radial Nerve
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What nerve entrapment can occur in the flexor compartment of the forearm?
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Pronator Teres: Median Nerve
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Name what is just lateral to:
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Flexor Carpi Ulnaris
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Ulnar Nerve and Ulnar Artery
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Palmaris Longus
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Median Nerve
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Flexor Carpi Radialis
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Radial Artery
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Thorax
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Name 2 palpable sternal landmarks.
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Sternal Angle (2nd costal cartilage) T4 vert.
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When inserting a needle between the intercostal spaces, where should the needle be inserted?
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What is it called when air enters the pleural space of the lungs?
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Pneumothorax
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What recesses are found in the pleura of the lungs?
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Costomediastinal Recess
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What is the location of the costomediastinal recess?
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Midclavicular
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Location of the costodiaphragmatic recess?
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Midaxillary 8 – 10 Intercostal Space
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What is it called when blood enters the pontential space of the pericardium between the visceral and pariental serous layers?
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Cardiac Tampenod
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What is the fossa ovalis?
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Remains of the embryologic Foreman Ovalis
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What occurs if foramen still exits?
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Murmur – deoxygenated blood entering systemic circulation
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Where is the SA node located?
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Base of SVC at cranial end of terminal crest
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Where is the AV node located?
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Septal wall near opening of coronary sinus
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What is the action of the inner cardiac muscles? (Outer)
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Squeeze (Twist)
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Cardiac Ascultation
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Aortic Valve?
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Right 2nd intercostal space
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Pulomonary Trunk valve?
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Left 2nd intercostal space
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Tricuspid valve?
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Left 5th intercostal space (parasternal)
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Mitral (Bicuspid) Valve?
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Left 5th intercostal space (3 inches left)
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Posterior Mediastinum
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What is esophageal varicies?
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Swelling of the esophageal veins due to blockage of the IVC
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What vertebral level is the aortic hiatus, INV hiatus, esophageal hiatus?
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T12, T8, T10
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