Upper Extremity Patho

Front 1

Injuries to the Clavicle

Back 1

• Falls on shoulder often fracture clavicle
• Shoulder separation=acromioclavicular and coracoclavicular ligaments tear

Front 2

Injuries to the Clavicle: Shoulder separation=acromioclavicular and coracoclavicular ligaments tear what muscles? and potentially cause what characteristic sign?

Back 2

• ernocleidomastoid elevates medial fragment, trapezius drops lateral fragment, lat dorsi and pec major adduct and medially rotate the lateral fragment
• These muscles cause the clavicle to shorten after a fracture.

Front 3

Injuries to the Clavicle: Shoulder separation=acromioclavicular and coracoclavicular ligaments tear what muscles?

Back 3

- ernocleidomastoid elevates medial fragment,
- trapezius drops lateral fragment,
- lat dorsi
- pec major adduct and medially rotate the lateral fragment

Front 4

Winged scapula is usually due to what?

Back 4

Injury of serratus anterior: usually from an injury to the long thoracic N that supplies the serratus anterior

Front 5

S/S of winged scapula?

Back 5

• Medial border and inferior angle of scap stand out
• Cant abduct arm past horizontal b/c cant rotate scapula

Front 6

Erbs Palsy/ Injuries of upper brachial plexus is due to?

Back 6

• Excessive separation of neck and shoulder
• Typically when tackled by the arm and facemask
• Or if thrown from a motorcycle, violent stretching of infant neck during delivery, stab wound/bullet to the neck

Front 7

Erbs Palsy/ Injuries of upper brachial plexus causes?

Back 7

loss of flex, abduction, lat rotation of shoulder and loss of flex of elbow

Front 8

Which dorsal roots are affected in Erb's Palsy?

Back 8

C5/C6

Front 9

Muscles that can be effected in Erbs Palsy?

Back 9

delto, biceps, brachialis, brachioradialis, supra and infraspinatius, teres minor

Front 10

Klumpke’s paralysis/lower brachial plexus injuries is caused by?

Back 10

Injury to inferior trunk when person grasps something to break a fall or the arm is pulled superior

Front 11

What nerves are damaged in Klumpke's paralysis?

Back 11

• C8-T1 injured-pulls dorsal and ventral nerve roots out of spinal cord
• Cause problems with anything supplied by ulnar N

Front 12

Thoracic outlet syndrome, Possible causes:

Back 12

cervical rib, poor posture, trauma, repetitive activity (like typing), obesity, oversized bags on shoulders, pregnancy

• Sensory fibers more affected

Front 13

Breast cancer, Clinical sign:

Back 13

when pec major contraction causes breast to move superiorly

Front 14

Lymph from breast can

Back 14

spread to other node including supraclavicular or abdomen Or axillary nodes which are most common site of metastases

Front 15

Peau d’orange

Back 15

skin change seen in breast cancer patients

Front 16

Mammography

Back 16

radiographic technique to test for breast cancer

Front 17

Thermograpy

Back 17

uses heat to find cancer b/c tumors give off more heat

Front 18

CT uses what for breast cancer pt's?

Back 18

iodine to highlight unusual breast features

Front 19

Axillary N injury (C5-C6) S/S and causation?

Back 19

• Injured during humerus fracture or shoulder dislocation
• Deltoid and paralyzed and undergoes atrophy

Front 20

Thoracodorsal N injury (C6, C7, C8) S/S and causation?

Back 20

• Can be injured during surgery of the axilla
• Results in paralysis of lat dorsi

Front 21

Lymphangitis

Back 21

• Redness, heat, tenderness of skin
• Lymph nodes enlarge commonly in pectoral region and breast
• Can be from infection or cancer

Front 22

Most common rotator cuff injuries in young people?

Back 22

• Supraspinatus most commonly torn, but not in younger people b/c it is so strong it will just tear the greater tubercle of the humerus

Front 23

Rupture of rotator cuff?

Back 23

occurs when older person strains to lift something and a degenerated tendon tears or happens in athletes

Front 24

Diseases affecting rotator cuff?

Back 24

degenerative tendonitis

Front 25

Common injury in baseball players?

Back 25

supraspinatus tear

Front 26

Calcific supraspinatous tendonitis

Back 26

calcium deposits in roator cuff, causes pressure causing pain during abduction then will cause the subacromial bursitis

Front 27

Subacromial bursitis

Back 27

o Separation of supraspinatus from coracoacromial ligament, acromion and delt due to a bursa
o Abduction of arm is painful

Front 28

Humerus injuries

Back 28

• More common in elderly during a fall on arm or elbow
• Axillary, ulnar and radial N can be damaged
• Affecting the pec major, teres major, lat dorsi
• Can dislocate shoulder if extended or laterally rotated excessively

Front 29

Student Elbow

Back 29

• Olecranon bursa becomes inflamed due to continuous friction
• Can also be injured in falls or infection when skin around that area is cut

Front 30

Brachial A injuries can result in?

Back 30

o hypoxia that within hours the deep flexors necros and be replaced by scar tissue. Muscles will become shortened: Volkmans ischemic contracture
o Loss of hand power can result from improper tourniquet uses

Front 31

Laceration of A is a surgical emergency b/c within hours the deep flexors will undergo necrosis that will be replaced by scar tissue and those muscles will become shortened

Back 31

Volkmans ischemic contracture

Front 32

Median N injury can result in?

Back 32

• Loss of sensaton in lateral palm, thumb, and digits 2 and 3
• Pronation, flexion of wrist and digits (IP joints, MP joints), and movements of thumb (opposition) are lost or lessened

Front 33

Median N injury can occur from?

Back 33

because of wrist slashing during suicide attempts

Front 34

Median N is located where at the elbow?

Back 34

• Proximal to the elbow

Front 35

Pronator Syndrome

Back 35

• Entrapment of median N near the elbow b/t two heads of pronator teres

Front 36

Entrapment of median N near the elbow b/t two heads of pronator teres

Back 36

Pronator Syndrome

Front 37

Pronator Syndrome is often caused from?

Back 37

• repeated elbow movements, trauma, muscular hypertrophy, fibrous bands

Front 38

Unlar N injury can occur where?

Back 38

The n. passes posterior to medial epicondyle of humerus and hit the bone on a hard surface

Front 39

Unlar N injury can result in?

Back 39

• Impaired flexion and adduction of wrist
• Impaired movements of thumb (adduction), ring finger, and pinkie=poor grasp

Front 40

Clinical sign of ulnar n. injury?

Back 40

cant adduct or abduct medial 4 digits due to loss of interosseous power; so cant make fist

Front 41

Commonly called claw hand- hyperextended MP and flexes IP

Back 41

Unlar N injury

Front 42

Entrapment (Canal of Guyon)

Back 42

causes numbness in 4th and 5th finger and palm of hand, motor neuropathy of muscles supplied by ulnar N

Front 43

Radial N injury may result in

Back 43

• inability to extend elbow or wrist
• inability to extend thumb of metacarpophalangeal joints of other fingers
• Paralysis of triceps, brachioradialis, anconeous, supinator, and extensors of wrist and digits

Front 44

Wrist drop

Back 44

Radial N injury: from entrapment in middle arm (normal strength of triceps though)

Front 45

Saturday night palsy

Back 45

Radial n. injury: From improper positioning of arm during sleeping

Front 46

Radial N injury may be from?

Back 46

poor fitting crutches, wrist drop, Saturday night palsy

Front 47

Superficial branch of radial n. injury would result in?

Back 47

• Loss of sensation in posterior surface of forearm and hand and lateral 3 ½ digits

Front 48

Musculocutaneous N injuries can result in?

Back 48

• paralysis of coracobrachialis, biceps, and brachials
• Flexion of elbow, and supination of forearm would be weakened
• Loss of sensation on lateral forearm from lateral cutaneous branch

Front 49

Ganglion is what?

Back 49

• Swelling of tendon on posterior hand or wrist
• Flexion makes it worse and extension makes it smaller

Front 50

Tennis Elbow/Radioulnar bursitis is what?

Back 50

• Pain and tenderness distal to lateral epicondyle of humerus
• Results from premature degeneration of common extensor attachement

Front 51

Colles’ fracture

Back 51

Wrist injuries:
o Distal fragment of the radius is displaced posteriorly and radius and ulnar area at same horizontal level which is abnormal
o Silver fork or dinner fork deformity

Front 52

Most commonly Fx bone in the wrist?

Back 52

• Scaphoid most commonly fractured carpal bone
o Causes tenderness in the anatomical snuffbox
o Wont appear on an xray for a couple weeks

Front 53

Dupuytren’s contracture

Back 53

• Shortening and thinckening of palmar aponeurosis
• Pull digits into irreversible flexion

Front 54

Carpal Tunnel Syndrome

Back 54

• Compression of median N
• Tingling, anesthesia, hypoesthesia in digits
• Mostly in women btw 40 and 60
• Loss of strength of abductor pollicis brevis and opponens pollicis

Front 55

Carpal Tunnel Syndrome can be treated by

Back 55

partial or complete division of flexor retinaculum=carpal tunnel release

Front 56

carpal tunnel release

Back 56

partial or complete division of flexor retinaculum

Front 57

Pulled elbow can be caused by?

Back 57

• Child is lifted by upper extremity and tears the distal attachment of the annular ligament where it is attached to the neck of the radius
• Radial head pulled out of annular ligament