Pathologies Of The Arm And Hand

Front 1

COLLE'S FRACTURE

What is the arm position?

Back 1

Flex Arm
Extend Forearm
ABduct Wrist

Front 2

COLLE'S FRACTURE

What can happen?

Back 2

1) Transverse Fracture across Distal Radius and displaced dorsally

2) The Ulnar Styloid is avulsed

Front 3

PARRY FRACTURE

What is the arm position?

Back 3

Arm is flexed and Pronated as if to block or defend a blow.

Front 4

PARRY FRACTURE

What Can happen?

Back 4

Fracture of distal Ulnar

Front 5

Fracture of the Schaphoid

What happens?

Back 5

Interrupt the blood flow to the distal artery and leaves the proximal part with out blood. It becomes narcotic and is replaced with the Palmaris Longus.

Front 6

CARPAL TUNNEL

What is CT and the symptoms?

Back 6

True CT is compression of the MN w/reulting sensory and motor deficits in the hand especially opposition of the thumb.

Front 7

CARPAL TUNNEL

What can cause the symptoms?

Back 7

Space Taking Lesions

1) Dislocated Lunate
2) Inflammation of the Synovial Sheath (SS)
3) Fluid Accumulation
4) Tumor

Front 8

Synovial Sheath Infection

How occur?

Back 8

FDS & FDP SS can be infected from a laceration of D5 that is deep enough to hit the SS. The SS of D5, FDS, and FDP are interconnected.

Any Digit can be lacerated and the SS become infected and have tendosynovitis

Front 9

What are Ganglion Cysts ("Bible Cysts")?

Back 9

Infection of the SS which creates nodules.

Front 10

CUBITAL FOSSA TRAUMA

What is its border and its contents?

Back 10

A line connecting the medial and lateral epicondyle, the Pronator Teres and Brachialradialis.

CONTENTS
1) Brachial Artery
2) Median nerve
3) Radial Artery
4) Radial Nerve
5) Ulnar Artery

Front 11

Ulnar Nerve Pases thru where?

A temporary lesion would cause?

Back 11

1) Between the olecranon and the medial epicondyle

2) Tingling in Digits 4 and 5

Front 12

Median Exits the Cubital Fossa how?

What is the possible pathology ?

Back 12

1) By passing between the two heads of the pronator trees.

2) if the Pronator Teres hypertrpohys then the median nerve could be compressed

Front 13

What is the Median Nerves path down the arm?

What is the possible pathology?

Back 13

1) The MN passes deep <> the FDS & FDP and becomes shallow at PL and next to Flexi Carpi Radialis.

2)If the FDS swells the MN could be compressed

3) Laceration of the rise could knock out the Median Nerve in the wrist. Losing the Thenar Compartment and lumbricals for D2 and D3

Front 14

What are the results from a recurrent median nerve branch lesion?

APE HAND

If laceration at wrist?

Back 14

1) REDUCED Flexion of Thenar MS. FPL is still working because it is innervated by the MN C7-C8 in the forearm

2) REDUCED ABduction because ABPL is innervated by Radial Nerve C7-C*

3) LOSE ALL opposition of the thumb

4) ADductor Pollicis inn by Deep Branch Ulnar Nerve C8-T1

THEREFORE, the thumb would lie next to D2 because it can oppose and would have wasting of thenar muscles= "Ape Hand".

If lacerated at the wrist, the above would be true and would lose feeling in the palm due to the loss of the Palmar Cutaneous Nerve

Front 15

DDE TRIANGLE MEMBRANE OR CENTRAL BAND INJURY

Boutonniere Deformity

Back 15

First understand that the central band inserts on the middle phalanx and tethers the proximal end of the Triangle Membrane. The Triangle Membrane tethers the Lateral Bands (which are attached to the DP) dorsally. The Lateral Bands are dorsal to the PIP and allow it to extend that Joint.

Any damage to the Triangle Membrane directly or indirectly through a Central Band injury would allow the Lateral bands to move ventrally thereby placing the PIP in permanent flexion

Front 16

DDE OBLIQUE LIGAMENT OR LATERAL BAND INJURY

Swan Neck Deformity

Back 16

The Oblique Ligament is a dorsal to ventral ligament that tether the Lateral Bands ventrally by crossing the PIP and insert ventrally on the PP.

If the Lateral Band is injured directly to indirectly by an injury to the Oblique Ligament, will cause the Lateral Band to move dorsally and put the PIP in permanent hyperextension.

Front 17

UPPER BRACHIAL PLEXUS LESION C5-C6

Erb Duchenne Palsy (aka Waiter's Tip position)

Back 17

All muscles innervated by C5-C6 fibers are affected. This leaves the arm and forearm in a

Arm: ADducted, medially rotated
Forearm: extended
Hand: Flexed

Front 18

RADIAL NERVE LESION

Wrist Drop

Back 18

Radial nerve innervates all the extensors with this lesion the flexors have no unopposed force putting the wrist into Flexion

Front 19

MEDIAN NERVE LESION OF THE LUMBRICALS

Hand of Benediction

Back 19

Lumbricals of D2 & D3 are innervated by Median Nerve C8 - T1 and they do simultaneous MP Flexion and IP extension.

D2 and D3 also have the D & P Interossei for MP flexion and Ip extension. Therefore there would be some loss of these actions. Leaving D2 and D3 without the ability to extend or alex completely and would have a clawing look.

Front 20

ULNAR NERVE LESION

Claw Hand

Back 20

Laceration of the Ulnar Nerve at the wrist would lose inn to D4 & D5 Lumbricals, D & P Interossei, which does MP extension and IP flexion.

D4 and D5 have severe clawing
D2 & D3 have some clawing because Lumbricals are inn by Median nerve

Front 21

Dupuytren's Contracture

Back 21

Shortening, thickening, and fibrosis of palmar fascia and aponeurosis.

Didget contraction and wrinkling of the skin

Front 22

TESTING

Flexor Digitorum Superficialis

Back 22

1) forceablly extend digits 3-5
2) Flex Digit 2 at PIP
3) Because the FDP tendons are on stretch they can't contract.

Front 23

TESTING

Flexor Digitorum Profundus

Back 23

1) Stabilize PIP and Flex DIP of any digit
2) FDS is on stretch therefore can't work
3) Test 2 Nerves - Ulnar and Median

Front 24

TESTING

Pronator Quadratus

Back 24

1) Flex Elbow - Pronator Teres is now near its origin and not capable to torque because its flaccid
2) Pronate