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Anatomy Tom Dick Har
For Anatomy test 2
| Question | Answer |
|---|---|
| What forms the superomedial border of the popliteal fossa? | semitendinosus and semimembranosus |
| What forms the inferomedial border of the popliteal fossa? | medial head of the gastrocnemius |
| what forms the floor of the popliteal fossa? | femur, oblique popliteal ligament, popliteus muscle |
| What forms the superolateral border of the popliteal fossa? | biceps femoris |
| What forms the inferolateral border of the popliteal fossa? | Lateral head of the gastrocnemius, plantaris |
| What important structures are located in the popliteal fossa? | popliteal artery and vein, small saphenous vein, common peroneal and tibial nerves, posterior cutaneous nerve of thigh, popliteal lymph nodes |
| What ankle ligaments are on the lateral aspect of the ankle? | anterior talofibular, calcaneofibular, posterior talofibular |
| What are the medial ligaments of the ankle? | tibiotalar, tibionavicular, tibiocalcaneal |
| What ligament runs from the calcaneous to the cuboid and is important in maintaining the longitudinal arch? | Long plantar ligament |
| What ligament runs from the calcaneus to the navicular and is important in maintaining the longitudinal arch and transferring the weight from the talus? | plantar calcaneonavicular (spring ligament) |
| What ligament is located between the spring and long plantar ligaments and is important in maintaining the longitudinal arch? | plantar calcaneocuboid (short plantar ligament) |
| What nerves innervate the muscles of the lower leg? | tibial, sural(cutaneous), common (fibular)-->peroneal to the anterior leg, medial and lateral plantar nerves, calcaneal branch to the heel |
| What arteries supply the lower leg? | popliteal, anterior tibial, posterior tibial, peroneal, medial/lateral plantar |
| What nerve innervates the plantar foot? | tibial nerve |
| The tibial nerve divides into what two branches in the plantar foot? | medial and lateral plantar |
| The medial plantar nerve innervates which muscles? | flexor digitorum brevis, abductor hallucis, flexor hallicus brevis, 1st lumbrical |
| The lateral plantar nerve innervates which muscles? | quadratus plantae, abductor digiti minimi, 2,3,4 lumbricals, abductor hallucis, flexor digiti minimi brevis, plantar and dorsal interossei |
| The popliteal artery branches into which two arteries? | posterior tibial and anterior tibial |
| The posterior tibial artery branches into which 3 arteries? | peroneal, lateral and medial plantar |
| The anterior tibial artery eventually becomes what artery? | dorsalis pedis |
| The Lateral plantar and dorsal pedis arteries form what? | the plantar arterial arch |
| The great saphenous vein drains into what vein? | femoral vein |
| The small saphenous vein drains into what vein? | popliteal vein |
| Describe the venous drainage on the medial side of the foot? | medial side into great saphenous-->into femoral |
| Describe the venous drainage on the lateral side of the foot? | lateral side into small saphenous into popliteal |
| What type of fascia surrounds the entire lower leg? | crural fascia |
| Describe the location of arteries, veins, and nerves superficial to deep in the lower leg. | nerves, veins, arteries |
| What is the most superficial of the 3 main central components of the popliteal fossa? | tibial nerve |
| How does the tibial nerve bisect the popliteal fossa? | from the superior to the inferior angle |
| How does the tibial nerve branch in the lower leg? | it branches to the soleus, gastrocs, plantaris, and popliteus muscles |
| What nerve does the tibial nerve give off? | the medial sural cutaneous-->which joins the sural communicating branch off the common peroneal to form the sural nerve |
| what is considered the deepest, most anterior portion of the popliteal fossa? | popliteal artery |
| What do the popliteal lymph nodes drain into? | the deep inguinal nodes |
| What are the 3 different compartments of the lower leg? | anterior (dorsiflexor), lateral (everter), posterior (plantarflexor) |
| What are the two thickenings of fascia in the anterior compartment called? | superior extensor retinaculum, inferior extensor retinaculum |
| What is known as the largest compartment of the lower leg? | the posterior compartment |
| These 3 compartments in the lower leg are formed by what? | the anterior and posterior intermuscular septa and the interosseous membrane |
| What muscle in the posterior compartment crosses the knee? | gastrocnemius |
| What muscle in the posterior compartment does not cross the knee? | soleus |
| What muscle has a long tendon that attaches to the achilles tendon? | plantaris |
| Where does the gastrocneumius originate? | on the lateral and medial femoral condyles |
| Which muscles insert into the calcaneal tendon? | gastroc, soleus, plantaris |
| Which muscles are innervated by the tibial nerve S1, S2? | gastroc, soleus, plantaris |
| What are the actions of the gastroc? | plantarfleses ankle when knee is extended, flexes knee, raises foot |
| What muscle plantarflexes the foot and stabilizes the leg on the foot? | soleus |
| Where does the soleus originate? | posterior and superior fibula, medial border of tibia, tendinous arch of soleus |
| What muscle assists with plantarflexion? | plantaris |
| Where does the plantaris originate? | on the supracondylar line of the femur |
| What two muscles originate on the interosseous membrane? | tibialis posterior, flexor hallucis longus |
| Where else does the tibialis posterior originate besides the interosseous membrane? | on the posterior surface of the tibai and fibula |
| Where does the tibialis posterior insert? | occupies the medial malleolar groove and inserts into the tarsal bones the 2,3, and 4 metatarsal bones |
| What innervates the tibialis posterior? | tibial nerve L4, L5 |
| What muscles plantar flex the ankle and invert the foot? | tibialis posterior, flexor digitorum longus, extensor hallucis longus |
| Where does the FDL originate? | on the medial portion of the posterior surface of the tibia |
| Where does the FDL insert? | on the 2-5 distal phalanges |
| What other action does the FDL have? | it flexes the toes |
| What muscles are innervated by the tibial nerve S2, S3? | FDL, EHL |
| where else does the FHL originate besides the interosseous membrane? | lower 2/3 of the posterior fibular surface |
| Where does the FHL insert? | runs along groove on the posterior talus body and on the inferior surface of the calcaneous (sustentaculum tali) to the distal phalanx of the great toe |
| What other action does the FHL have? | it flexes the great toe |
| How many muscle layers are in the sole of the foot? | 4 |
| What muscles are located in layer 1 (most superficial) of the foot? | abductor hallucis, flexor digitorum brevis, abductor digiti minimi |
| What muscles are in layer 2 of the foot? | quadratus plantae, lumbricals |
| what muscles are in layer 3 of the foot? | flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis |
| What muscles are in layer 4 of the foot? | plantar interossei, dorsal interossei |
| What are the movements of the ankle? | supination (inversion), pronation (eversion), dorsiflexion, plantarflexion |
| What constitutes the lateral collateral ligaments of the ankle? | anterior talofibular, calcaneofibular, posterior talofibular |
| What constitutes the syndesmosis of the ankle? | anterior inferior tibiofibular, posterior inferior tibiofibular, inferior transverse |
| What are the 2 parts of the deltoid ligament called? | supeficial and deep |
| What ligaments are located in the deep layer of the deltoid ligament? | anterior deep tibiotalar, posterior deep tibiotalar |
| what ligaments are located in the superficial layer of the deltoid ligament? | tibionavicular, tibiocalcaneal, posterior tibiotalar |
| What are you looking for when performing the anterior drawer test on the ankle? | subluxation of the talus out of the mortise joint |
| What percentage of ankle fx involve a supination/adduction mechanism? | 10-20% |
| What is the associated pathology with a supination/adduction mechanism? | transverse # of fibula/tear of collateral ligaments-->vertical # medial malleolus |
| What percentage of ankle fx involve a supination/eversion (external rotation) mechanism? | 40-75% |
| What is the associated pathology with a supination/eversion mechanism? | disruption of the anterior tibiofibular ligament, spiral oblique fx of the distal fibula, disruption of the posterior tibiofibular ligament or fx of the posterior malleolus, fx of the medial malleolus or rupture of the deltoid ligament |
| What percentage of ankle fx involve a pronation/abduction mechanism? | 5-20% |
| What is the associated pathology with a pronation/abduction mechanism? | transverse fx of the medial malleolus or rupture of the deltoid ligament, rupture of teh syndesmotic ligaments or avulsion fx of their insertions, short, horizontal, oblique fx of the fibula above the level of the joint |
| What percentage of ankle fx involve a pronation/eversion mechanism? | 5-20% |
| What is the associated pathology with a pronation/eversion mechanism? | transverse fx of the medial malleolus or disruption of the deltoid ligament, disruption of anterior tibiofibular ligament, short oblique fx of the fibula above the level of the joint, rupture of posterior tibiofibular ligament or avulsion fx of the tibia |
| What is the associated pathology with a pronation/dorsiflexion mechanism? | fx of medial malleolus, fx of anterior margin of tibia, supramalleolar fx of fibula, transverse fx of the posterior tibial surface |
| What is the only type of ankle fx associated with medial displacement of the talus? | supination-adduction mechanism |
| What are some complications of calcaneal fx? | wound dehiscence, calcaneal osteomyelitis, post-traumatic arthritis, increase heel width--lateral impingement of peroneal tendon, loss of subtalar motion, peroneal tendonitis, sural nerve injury, chronic pain, reflex sympathetic dystrophy |
| Describe a type I talar fx | nondisplaced |
| Describe a type II talar fx | associated subtalar subluxation or dislocation |
| Describe a type III talar fx | associated subtalar and ankle dislocation |
| Describe a type IV talar fx | type III with associated talonavicular subluxation or dislocation |
| What is the mechanism of action behind the snowboarders talus | dorsiflexion and inversion |
| What are some complications of talar fxs? | infection, osteonecrosis, delayed union or nonunion, malunion, interposition of long flexor tendons, foot compartment syndrome |
| where is chopart's joint located? | between the calcaneous and the cuboid bone and the talus and navicular bone |
| Describe the mechanism of injury for a medial stress injury in the midtarsal joint? | adduction of midfoot on hindfoot |
| describe the associated pathology with a medial stress injury | avulsion fxs commonly seen, in more severe cases, joint may be dislocated (talonavicular), subtalar joint is subluxed and the calcaneocuboid joint is intact |
| describe the mechanism of injury for a longitudinal stress injury of the midtarsal joint | longitudinal forces through metatarsals produce vertical navicular fxs |
| describe the mechanism of injury for a lateral stress injury of the midtarsal joint | forefoot is driven laterally causing a nutcracker fx, crushing the cuboid between teh calcaneous and 4/5 metatarsal bases |
| Describe the lisfranc joint line | the anatomic boundary between the rigid midfoot and the suppler weightbearing forefoot |
| What is the MOI for a Lisfranc injury? | severe twisting, axial loading or crushing mechanisms |
| What are the complications of a lisfranc injury? | post-traumatic arthritis, compartment syndrome, infection, RSD, neurovascular injury, hardware failure |
| What is a Jones fx? | a fx of the base of the 5th metatarsal |
| What tendon attaches to the base of the 5th MT? | peroneus brevis |
| What is the MOI of a jones fx? | direct trauma or rotational force |
| What is the innervation discussed in the posterior thigh region? | tibial division of sciatic, common peroneal division of sciatic, posterior cutaneous nerve of thigh, tibial, common peroneal |
| In what compartment are the sciatic nerve and perforating blood vessels found? | posterior compartment |
| Each compartment is formed by what? | 3 fascial intermuscular septae |
| What is found in the anterior compartment of the leg? | extensor compartment, femoral nerve |
| What is found in the medial compartment of the leg? | adductor compartment, obturator nerve |
| What is found in the posterior compartment of the leg? | flexor compartment, tibial and common peroneal divisions of the sciatic nerve |
| What muscles are found in the posterior compartment of the thigh? | biceps femoris, semitendinosus, semimembranosus |
| What muscles are located in the medial compartment of the thigh? | adductor magnus, adductor brevis, gracilis, adductor longus |
| What muscles are located in the lateral compartment of the thigh? | gluteus maximus, fascia lata |
| What muscles are located in the anterior compartment of the thigh? | vastus lateralis, vastus intermedius, vastus medialis, rectus femoris, sartorius |
| What forms the superior border of the femoral triangle? | inguinal ligament |
| What forms the medial border of the femoral triangle? | adductor longus |
| What forms the lateral border of the femoral triangle? | sartorius |
| What forms the floor of the femoral triangle? | pectineus |
| What are the contents--from lateral to medial--of the femoral triangle? | femoral nerve, femoral artery, femoral vein, empty space, lymphatics |
| The adductor canal does what? | It allows passage of the femoral vessels and the saphenous nerve through the middle one-third of the thigh. |
| where are the quadriceps femoris muscles in relationship to the adductor muscles? | they are separated by a deep groove |
| What forms the roof of the adductor canal? | sartorius |
| Where does the adductor canal end? | the adductor hiatus |
| Anatomically, what is the adductor hiatus? | a split in the adductor magnus muscle |
| What arteries supply the anterior compartment of the thigh? | femoral and deep femoral |
| What arteries supply the medial compartment of the thigh? | obturator and deep femoral |
| What arteries supply the knee? | popliteal, anterior tibial, peroneal, posterior tibial |
| What innervates the anterior thigh? | femoral nerve (L2-L4) |
| What innervates the medial thigh? | obturator nerve (L2-L4) |
| What muscles are located in the anterior thigh? | pectineus, iliopsoas, sartorius, quadriceps femoris, articularis genu |
| What muscles are located in the medial thigh? | pectineus, adductor longus, adductor brevis, adductor magnus, gracilis, obturator externus |
| What is the action of the iliopsoas muscle? | it flexes the hip joint |
| What muscles cross the hip joint? | rectus femoris, adductor muscles |
| What is fxn unique to the rectus femoris? | it acts as a hip flexor |
| Describe where the quadriceps femoris originates. | 1 head arises from the AIIS and 3 heads arise from the femur |
| What do the adductor muscles do? | bring legs together |
| What muscle is known as the transitional muscle between the anterior and medial compartments? | pectineus |
| Where does the pectinus originate? | on the superior ramus of the pubic bone |
| Where does the pectineus insert? | on the upper medial shaft of the femur |
| What muscles are innervated by the femoral nerve L2-L4? | pectineus, iliopsoas, sartorius, quadriceps femoris |
| What muscles adduct the thigh? | adductor longus, pectineus, adductor brevis, adductor magnus |
| What muscle flexes the thigh? | pectineus |
| What muscle is the chief flexor of the thigh and the most powerful of the hip flexors? | iliopsoas |
| Where does the iliopsaos originate? | T12-L5, superior 2/3 of the iliac fossa |
| Where does the iliopsoas insert? | on the lesser trochanter of the femur |
| What other nerve (besides the femoral) innervates the iliopsoas? | ventral rami L1-L4 |
| What muscles flex the hip? | iliopsoas, sartorius, rectus femoris |
| Where does the sartorius originate? | ASIS |
| What two muscles insert on the upper part, and medial surface of the tibia, aka the pes anserine area? | sartorius and gracilis |
| What muscles flex the knee? | sartorius, gracilis, |
| Where does the rectus femoris originate? | AIIS |
| Where does the vastus group originate? | on the upper half of the shaft of the femur |
| Where do the quadriceps insert? | on the quad tendon via the patella via the patellar tendon and medial and lateral patellar retinacula |
| What muscles extend the knee? | rectus femoris, vastus group |
| What muscles insert on the anterior part of the pubic bone? | adductor longus, adductor brevis |
| What muscle inserts on the middle part of the femur? | adductor longus |
| What muscles insert on the linea aspera of the femur? | adductor longus,adductor brevis, adductor magnus |
| What muscles are innervated by the obturator nerve L2-L4? | adductor longus, adductor brevis, adductor magnus, gracilis, obturator externus |
| What muscle divides the anterior and posterior branches of the obturator nerve? | adductor brevis |
| What muscle inserts on the proximal part of the femur? | adductor brevis |
| What muscles originate on the inferior pubic ramus? | adductor magnus, gracilis |
| What muscle also originates on the ischial ramus and tuberosity? | adductor magnus |
| Where else does the adductor magnus insert? | into the adductor tubercle of the femur |
| What muscle is the largest, most powerful, most posterior of adductors? | adductor magnus |
| What else innervates the adductor magnus? | the tibial portion of the sciatic nerve supplies the hamstring portion |
| What muscle extends the thigh? | adductor magnus |
| What muscle adducts the hip? | gracilis |
| What is special about the gracilis? | It is the most medial muscle of the thigh |
| What muscle passes direclty under the acetabulum and the neck of the femur? | obturator externus |
| What muscle originates on the external surface of the obturator foramen and membrane? | obturator externus |
| Where does the obturator externus insert? | into the trochanteric fossa of the femur |
| What is the main action of the obturator externus? | external rotation of thigh |
| When a person performs a straight leg raise, what is the force muliplier? | 1.5 body weight |
| When a person stands on one-leg, what is the force multiplier? | 2.5 body weight |
| When a person stands on both feet, what is the force multiplier? | 0.5 body weight |
| When a person runs, what is the force multiplier? | 5.0 body weight |
| What vessel supplies the majority of the femoral head? | medial femoral circumflex artery |
| What artery supplies a small contribution to the femoral head? | artery of ligamentum teres |
| What is a consequence of the femoral neck having minimal periosteum? | any callus that forms must do so by endosteal proliferation-->making it prone to avascular necrosis |
| What are some symptoms of nonunion in femoral neck fxs? | groin/buttock pain, pain on hip extension, painful weightbearing for at least 12 months |
| What fxs are 50% of all fxs of the proximal femur? | intertrochanteric fxs |
| Describe the anatomy of the intertrochanteric area? | extracapsular, good cancellous bone, abundant blood supply |
| What can result in a deformity of the intertrochanteric area? | shortening, external rotation, varus position |
| How do the abductors connect to the intertrochanteric area? | they connect to the greater trochanter laterally and proximally |
| How does the illiopsoas connect to the intertrochanteric area? | it connects to the lesser trochanter medially and proximally |
| What can happen with an intertrochanteric fracture? | flexors, extensors, and adductors pull distal fragment proximally, can be non-displaced or displaced |
| What is the usual MOI for an intertrochanteric fx? | MVA, fall from a height in the young, a simple fall in the old, direct impact on greater trochanter |
| If an intertrochanteric fx is displaced, what are the likely radiographic findings? | it is shortened and externally rotated |
| What are some complications of intertrochanteric fxs? | loss of fixation, nonunion, malrotation deformity, laceration of the femoral artery by a displaced lesser trochanteric fragment, iatrogenic fx |
| Describe the anatomy of the subtrochanteric area. | it consists mainly of cortical bone, less vascularity, diminished potential for healing |
| What is the MOI for subtrochanteric fxs? | similar to other hip fxs, common site of pathological fxs |
| What defines a femoral shaft fx? | a fx of the femoral diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle |
| Describe the anatomy of the femoral shaft area. | good periosteal blood supply, vascular supply to shaft derived from deep femoral artery, large size of compartments make compartment syndrome less common than in leg |
| What is the MOI for a femoral shaft fx? | high energy activities (young men), low energy activities (elderly women) |
| What is seen in 50% of femoral shaft fx patients? | ligament and meniscal damage to the ipsilateral knee |
| How are femoral shaft fxs classified? | open vs. closed, location, pattern, comminuted, segmental or butterfly fragment, angulation or rotational deformity, displacement |
| What are some complications of a femoral shaft fx? | nerve injury, vascular injury to femoral artery tethered at adductor hiatus, compartment syndrome, infection, refracture, nonunion, malunion, fixation device failure, heterotrophic ossificstion |
| What is meant by heterotrophic ossification? | the process by which bone tissue forms outside of the skeleton |
| If hip fxs are excluded, ________of femur fractures involve what part? | One third of femur fxs involve the distal portion |
| The distal femur inovles what two regions. | the supracondylar, condylar |
| What is teh MOI for a distal femur fx? | severe axial lad with varus, valgus or rotation |
| What are some complicatiosn for a distal femur fx? | posttraumatic osteoarthritis, loss of knee motion, failure of fixation, nonunion, malunion, infection, etc. |
| In tibial plateau (proximal tibia) fxs, what can happen? | the popliteal trifurcation is tethered posteriorly and the peroneal nerve is tethered laterally around the fibular neck, compartment syndrome |
| What are the most common long bone fxs? | tibial and fibular shaft fxs |
| What vessels supply the tibial and fibular shaft? | nutrient artery and periosteal vessels |
| What is a tibial plafond fx? | A combination of ankle fx and distal tibial metaphyseal fx, usually with intraarticular comminution |
| What important structures are located in the anterior compartment of the leg? | anterior tibial and dorsalis pedis artery, deep peroneal nerve |
| What important structures are located in the lateral compartment? | superficial peroneal nerve, no arteries run through this |
| What is the fxn of the genicular anastomosis in the knee? | it can help supply blood to the leg in the event of an obstruction of the femoral artery below the branching--->off of the deep femoral artery |
| The popliteal artery gives rise to what two arteries? | post. and anterior tibial |
| The posterior tibial artery gives rise to what 3 arteries? | peroneal, lateral planar, medial planar |
| The anterior tibial artery gives rise to what artery? | dorsalis pedis |
| The lateral plantar, medial plantar, and dorsalis pedis arteries all contribute to what? | plantar arterial arch |
| What is the primary action of the muscles of the anterior leg? | dorsiflexion of the ankle and extension of the phalanges |
| What are the distal attachments of the muscles of the anterior leg? | tarsal, metatarsal, and phalangeal bones and joints |
| The muscles of the anterior compartment of the anterior leg are responsible for what motions? | dorsiflexion of the ankle and toe extension |
| What muscles make up the anterior compartment of the anterior leg? | tibialis anterior, extensor digitorum longus and brevis, extensor hallucis longus and brevis, peroneus tertius (although seen in the lateral aspect of the lower leg) |
| The muscles of the lateral compartment of the anterior leg are responsible for what motion? | eversion of the ankle |
| What are the muscles of the lateral compartment? | peroneus longus and brevis |
| How do the tendons run? | They pass under several different retinaculum above and below ankle. |
| Where does the tibialis anterior originate? | on the upper, lateral, and anterior tibia |
| What muscles insert on the medial cuneiform and the base of the 1st metatarsal? | tibialis anterior, peroneus longus |
| What muscles are innervated by the deep peroneal nerve? | tibialis anterior, Extensor Digitorum Longus and Brevis, Extensor Hallucis Longus, Extensor Hallucis Brevis, peroneus tertius |
| What muscles dorsiflex the foot? | tibialis anterior, extensor hallucis longus, peroneus tertius |
| What muscles invert the foot? | tibialis anterior, extensor hallucis longus, |
| What muscles originate on the anterior fibula? | extensor digitorum longus, extensor hallucis longus |
| What muscles originate on the interosseus membrane? | extensor digitorum longus, extensor hallucis longus, peroneus tertius |
| What origin is unique to the extensor digitorum longus? | lateral tibial condyle |
| What muscles originate on the dorsal calcaneus? | extensor digitorum brevis, extensor hallucis brevis |
| Where does the extensor digitorum longus insert? | mid/distal phalanges of the lesser toes |
| Where does the extensor digitorum brevis insert? | proximal phalanges of the lesser toes |
| What muscles extend the toes? | EDL and EDB |
| What muscles dorsiflex the ankle? | EDL and EDB |
| What muscles evert the foot? | EDL, EDB, peroneus tertius, peroneus longus, peroneus brevis, |
| Where does the extensor hallucis longus insert? | on the distal phalanx of the great toe |
| What muscles extend the great toe? | extensor hallucis longus, extensor hallucis brevis, |
| Where does the extensor hallucis brevis insert? | at the base of the proximal phalanx of the great toe |
| Where else does the peroneus tertius originate besides the interosseous membrane? | lower anterior fibula |
| Where does the peroneus tertius insert? | the dorsum of the base of the 5th MT |
| Where does the peroneus longus originate? | on the head and upper 2/3 lateral side of the fibula |
| What muscles are weak plantarflexors of the ankle? | peroneus longus, peroneus brevis |
| What nerve innervates the peroneus longus and brevis? | superficial peroneal |
| Where does the peroneus brevis originate? | the lower 2/3 lateral side of the fibula |
| Where does the peroneus brevis insert? | on the dorsum lateral side of the base of 5th MT |
| What are teh exta and intra articular ligaments of the knee? | MCL, LCL, ACL, PCL |
| What is the role of the meniscus? | it absorbs impact and helps with stability |
| What about the vascularity of the meniscus? | it is avascular and heals slowly if at all |
| What ligaments are tight in flexion and extension, relaxed at 30 degrees of flexion and prevents anterior and posterior displacement of the tibia? | cruciates |
| What ligaments are tight in extension, relaxed in flexion, and prevents abduction/adduction of the knee? | collaterals |
| Which ligament of the knee is most often injured? | the MCL is weaker than the ACL and PCL and is most easily injured. |
| What is the terrible triad? | MCL, ACL, and the lateral and medial menisci are damaged when lateral trauma is applied to the knee while the foot is fixed to the ground |
| How do you assess the integrity of the MCL? | apply valgus stress to the knee |
| How do you assess the integrity of the LCL? | apply varus stress to the knee |
| What tests assess the integrity of the ACL? | anterior drawer, Lachman's |
| What tests assess the integrity of the PCL? | Posterior drawer, sag test |
| What is compartment syndrome? | an elevation of interstitial pressure in closed fascial compartment that results in microvascular compromise |
| What does the superficial fascia do? | it is the subcutaneous tissue of the neck that envelops the platysma muscle |
| What are the 3 layers of deep cervical fascia? | superficial (investing), pretracheal, prevertebral |
| What does the superficial (investing) layer do? | it surrounds the sternocleidomastoid muscle, the strap muscles, and the trapezius |
| Where is the pretracheal fasica located? | it lies anterior to the trachea and midline structures |
| What is the fxn of the prevertebral fascia? | It encloses the vertebral column and its associated muscles. |
| What does the deep cervical fascia do collectively as a unit? | it condenses around the carotid sheath, enclosing the common carotid arteries, internal jugular veins, and vagus nerves |
| Where are the lymphatics found? | within the superficial and deep fascia in order to contain disease process until it is eroded |
| What triangles make up the anterior triangle of the neck? | submandibular triangle, submental triangle, carotid triangle, muscular triangle |
| What triangles make up the posterior triangle of the neck? | occipital triangle, supraclavicular triangle |
| What is the significance of the sternocleidomastoid muscle? | it defines the borders between the anterior and posterior triangles. |
| What marks the anterior border of the anterior triangle? | the anterior midline of the neck |
| What marks the posterior border of the anterior triangle? | the anterior border of the SCM |
| What marks the superior border of the anterior triangle? | the inferior border of the mandible |
| What marks the roof of the anterior triangle? | the platysma and investing fascia |
| What marks the anterior border of the posterior triangle? | the posterior border of the SCM muscle |
| What marks the posterior border of the posterior triangle? | anterior border of the trapezius |
| What marks the inferior border of the posterior triangle? | the superior border of the clavicle |
| What marks the floor of the posterior triangle? | the splenius capitis, levator scapulae, scalenes |
| What marks the roof of the posterior triangle? | the platysma and investing fascia |
| In the posterior triangle, what structures are located superficial to the SCM? | external jugular vein, superficial cervical nodes, lesser occipital nerve, great auricular nerve, transverse cervical nerve, supraclavicular nerves, spinal accessory nerve |
| In the posterior triangle, what structures are located deep to the SCM? | spinal accessory nerve (a continuation of), brachial plexus, transverse cervical artery, suprascapular artery |
| What nerve roots make up the cervical plexus? | C1-C5 |
| What nerve roots make up the brachial plexus? | C5-T1 |
| In the cervical and brachial region, the common carotid artery gives rise to what artery? | vertebral |
| The vertebral artery gives rise to what artery? | Thyrocervical trunk |
| The thyrocervical trunk gives rise to what artery? | internal thoracic |
| The internal thoracic artery gives rise to what artery? | subclavian |
| The subclavian artery gives rise to what artery? | axillary |
| What arteries come off the 1st branch of the axillary artery? | superior thoracic |
| What arteries come off the 2nd branch of the axillary artery? | thoracoacromial, lateral thoracic |
| What arteries come off the 3rd part of the axillary artery? | subscapular, anterior circumflex humeral, posterior circumflex humeral |
| Name the branches of the thyrocervical trunk. | inferior thyroid, ascending cervical, transverse cervical, suprascapular |
| Where does the playsma originate? | on the subcutaneous fascia over the upper chest |
| Where does the platysma insert? | on the subcutaneous fascia of the chin and jaw, on the inferior border of the mandible |
| What nerve innervates the platysma? | facial nerve |
| What are the actions of the platysma? | lowers the corner of mouth, draws skin of chest upwards |
| What important structure travels over the anterior scalene? | phrenic nerve (C3-C5) |
| What important structure travels behind the anterior scalene? | brachial plexus |
| Where do the scalenes originate? | on the transverse processes of cervical vertebrae |
| Where do the scalenes insert? | anterior scalene and middle scalene: 1st ribposterior scalene: 2nd rib |
| What is the action of the scalene muscles? | primarily muscles of inspiration |
| What is the clinical significance of tight scalenes? | the subclavian artery and brachial plexus are located in this area, potentially leading to thoracic outlet syndrome |
| What muscles make up the anterior neck? | suprahyoid group, infrahyoid group |
| What muscles are part of the suprahyoid group? | digastric, stylohyoid, geniohyoid, mylohyoid |
| What muscles are part of the infrahyoid group? | sternohyoid, omohyoid, strenohyoid, thyrohyoid |
| What are colletively the actions of the muscles in the anterior cervical region? | they steady or move the hyoid and larynx |
| Where does the omohyoid originate? | near the suprascapular notch of the scapula |
| Where does the omyohyoid insert? | on the hyoid bone |
| What nerve innervates the omohyoid? | C1-C3 by the ansa cervicalis |
| What are the actions of the omohyoid muscle? | depresses, retracts, steadies hyoid |
| What are the deep muscles of the anterior neck? | longus colli, longus capitis, rectus capitis anterior, rectus capitis lateralis |
| Where are the deep muscles of the anterior neck located? | they lie against the anterior aspect of vertebrae |
| What are the fxns of the deep muscles of the anterior neck? | they stabilize the head and restore to neutral from neck extension |
| What muscles make up the anterior thorax? | subclavius, pectoralis major and minor |
| what is the specific location of the subclavius? | it extends from the 1st rib to the clavicle |
| What does the pectoralis major do? | it is involved in horizontal adduction of the humerus |
| What is the specific location of the pectoralis minor? | it extends from the ribs to the coracoid process (stabilizes scapula) |
| Where does the subclavius originate? | at the jxn of the 1st rib and costal cartilage |
| Where does the subclavius insert? | on the inferior surface of the mid 1/3 of the clavicle |
| What innervates the subclavius? | the nerve to the subclavius |
| What are the actions of the subclavius? | anchors and depresses the clavicle |
| Where does the pectoralis major originate? | clavicular head: medial 1/2 or 2/3 of claviclesternocostal head: sternum and adjacent 6 costal cartilages |
| Where does the pectoralis major insert? | upper shaft of the humerus |
| What innervates the pectoralis major? | upper fibers: lateral pectoral nervelower fibers: lateral and medial pectoral nerves |
| What are the actions of the pectoralis major? | adducts and internally rotates humerus, flexes and internally rotates shoulder joint, horizontally adducts the humerus, the main climbing muscle |
| Where does the pectoralis minor originate? | 3rd-5th ribs near the costal cartilages |
| where does the pectoralis minor insert? | on the coracoid process of the scapula |
| What innervates the pectoralis minor? | medial pectoral nerve |
| What are the actions of the pectoralis minor muscle? | stabilizes scapula by bringing it anteriorly and inferiorly against the thoracic wall |
| Where are the brachial plexus and axillary artery located in relationship to the pectoralis minor? | they are located beneath it |
| What is the clinical significance of a tight pectoralis minor muscle? | tight pec. minor compresses neurovascular, causes restriction of chest expansion |
| What are the roots of the brachial plexus formed by? | anterior (rami) of C5-T1 |
| Where do the root of the brachial plexus go? | they pass between the anterior and middle scalene with the subclavian artery |
| What do these roots form? | Trunks: Superior (C5-C6)Middle (C7)Inferior (C8) |
| Each trunk divides into what? | anterior and posterior divisions |
| What do these divisions form? | 3 cords: lateral, medial, posterior |
| What divisions form the lateral cord? | anterior divisions from the superior and middle trunk |
| What divisions form the medial cord? | the anterior divisions from the inferior trunk |
| What divisions form the posterior cord? | the posterior divisions from all 3 trunks |
| What do these trunks form? | branches |
| How are the cords of the brachial plexus named? | by their anatomical relationship to the axillary artery |
| Describe the shape of the terminal branches of the medial and lateral cords. | They make a sideways M |
| What nerve roots are involved in the supraclavicular branch of the brachial plexus? | C5 and C6 |
| What nerves come off the supraclavicular branch and arise from C5 only? | dorsal scapular and suprascapular nerves |
| What nerves come off the supraclavicular branch and arise from C6 only? | Nerve to the subclavius |
| What nerve comes off the supraclavicular branch and arise from both C5 and C6? | long thoracic nerve |
| The dorsal scapular nerve innervates what muscles? | Rhomboids, Levator scapulae |
| The long thoracic nerve innervates what muscle? | serratus anterior |
| What nerve roots are involved in the infraclavicular branch of the brachial plexus? | C5-T1 |
| What nerves come off the infraclavicular branch and arise from both C5-C7? | Lateral pectoral, musculocutaneous, medial pectoral, medial cutaneous nerve of arm, medial cutaneous nerve of forearm, median nerves |
| What nerves comes off the infraclavicular branch and arise from C5-T1? | Median, radial nerve |
| What muscle does the lateral pectoral nerve innervate? | pectoralis major |
| What muscles does the musculocutaneous nerve innervates? | all of the muscles of the anterior arm except for the coracobrachialis, biceps, and the brachialis |
| What muscles does the median nerve innervate? | all those in the anterior forearm except for the flexor carpi ulnaris, the ulnar half of the flexor digitorum profundus, 3 intrinsic thenar muscles, and the radial 2 lumbricals |
| What nerves come off the infraclavicular branch and arise from C8-T1? | medial pectoral, medial cutaneous nerve of arm, medial cutaneous nerve of forearm, ulnar nerve |
| What muscles does the medial pectoral nerve innervate? | pectoralis minor, the sternoclavicular part of the pectoralis major |
| What does the medial cutaneous nerve of the arm do? | it innervates the skin of the medial arm |
| What does the medial cutaneous nerve of the forearm do? | it innervates the skin of the medial forearm |
| What muscles does the ulnar nerve innervate? | flexor carpi ulnaris, ulnar half of the flexor digitorum profundus, most of the intrinsic hand muscles, skin of the hand |
| What brachial plexus root does the upper subscapular nerve arise? | C5 |
| What muscle does the upper subscapular nerve innervate? | the superior portion of the subscapularis |
| What brachial plexus root does the lower subscapular nerve arise? | C6 |
| What muscles does the lower subscapular nerve innervate? | the inferior portion of the subscapularis, teres major |
| What muscle does theh thoracodorsal nerve innervate? | latissimus dorsi |
| What muscles does the axillary nerve innervate? | deltoid, teres minor |
| What nerve roots does the thoracodorsal nerve arise from? | C6-C8 |
| What nerve roots does the axillary nerve arise from? | C5-C6 |
| What muscles does the radial nerve innervate? | all posterior muscles of the arm and forearm, the skin of the posterior and inferolateral arm and forearm and the dorsum of the hand lateral to the axial line of the ring finger |
| Erb's palsy involves damage to what aspect of the brachial plexus? | the superior trunk (aka waiter's tip) |
| Klumpke's paralysis involves damage to what aspect of the brachial plexus? | the inferior trunk (aka claw hand) |
| Wrist drop involves damage to what aspect of the brachial plexus? | radial nerve |
| A winged scapula involves damage to what aspect of the brachial plexus? | long thoracic nerve |
| Deltoid paralysis involves damage to what aspect of the brachial plexus? | axillary nerve |
| Saturday night palsy involves what type of damage? | radial nerve compression |
| Ape hand involves damage to what brachial plexus structure? | the median nerve (involves the thenar muscles) |
| Damage to the hand of benediction involves what nerve? | the ulnar nerve (paralysis of intrinsic muscles of hand) |
| If a person has radial deviation of the wrist with wrist flexion, what structure could be damaged? | the ulnar nerve above the elbow |
| The brachial artery is a continuation of what artery? | axillary artery |
| Describe the path of the brachial artery. | it begins at the inferior border of the Teres major and ends at the cubital fossa near the radial neck |
| What does the brachial artery divide into? | radial and ulnar arteries |
| What are the braches of the brachial artery? | deep artery of the arm, humeral nutrient artery (to the humeral shaft), superior and inferior ulnar collateral arteries |
| The deep artery of the arm is accompanied by what nerve? | the radial nerve |
| The deep artery of the arm divides into what? | middle and radial collaterals |
| The superior ulnar collateral artery is accompanied by what nerve? | ulnar nerve |
| The inferior ulnar collateral artery is located where? | it is the last branch above the cubital space |
| What are some important superficial veins of the arm? | cephalic in the forearm and in deltopectoral groove, median cubital, basilic |
| What are the four main nerves in the arm? | median (forearm, wrist, hand), radial (innervates wrist extensors, can be damaged in a midshaft humeral fx), ulnar, musculocutaneous (to the anterior muscles) |
| What is unique about the median and ulnar nerves? | there are no branches in the axilla or arm |
| How does the radial nerve descend? | it descends inferolaterally with the deep brachial artery and passes around the humeral shaft in the radial groove |
| How does the radial nerve enter the arm? | it enters the arm posterior to the brachial artery, medial to the humerus, and anterior to the long head of the triceps |
| How does the radial nerve continue inferiorly? | it continues inferiorly in the anterior compartment of the arm between the brachialis and the brachioradialis |
| Where does the radial nerve divide into deep and superficial branches? | anterior to the lateral epicondyle |
| The radial nerve is divided into what 2 branches? | deep (entirely muscular) and superficial (entirely sensory) |
| What does the radial nerve supply? | all of the muscles of the posterior compartment of the arm (and forearm) |
| Describe the course of the ulnar nerve. | it passes posterior to the medial epicondyle and medial to the olecranon to enter the forearm |
| The ulnar nerve supplies what muscles? | flexor carpi ulnaris, adductor pollicis, hypothenar muscles, flexor digitorum profundus (4/5), interosseii, lumbricals (4/5) |
| Describe the sensation distribution for the ulnar nerve. | hand, ulna, to the median line of the 4th MCP joint |
| Describe the course of the musculocutaneous nerve. | it begins opposite the inferior border of the pectoralis minor, pierces the coracobrachialis and continues distally between the biceps and the brachialis |
| The musculocutaneous nerve supplies what muscles? | biceps brachii, coracobrachialis, brachialis, sensation to lateral forearm |
| What separates the anterior from the posterior muscles of the arm? | the humerus and the medial and lateral intermuscular septae |
| What are the muscles of the arm? | biceps brachii, coracobrachialis, brachialis, triceps brachii, anconeus |
| What muscles originate on the coracoid process? | short head of the biceps brachii, coracobrachialis |
| Where does the long head of the biceps originate? | on the supraglenoid tubercle |
| Where does the biceps brachii insert? | on the radial tuberosity |
| What muscles are innervated by the musculocutaneous nerve (C5-C7)? | Biceps Brachii, coracobrachialis |
| What muscles flex the elbow? | biceps brachii, brachialis |
| What muscle supinates the forearm? | biceps brachii |
| Where does the coracobrachialis insert? | on the medial aspect of the humerus at the mid-shaft |
| What does the coracobrachialis do? | it helps flex and adduct the arm |
| Where does the anconeus originate? | lateral epicondyle of humerus |
| Where does the anconeus insert? | on the lateral olecranon and the superior part of the posterior surface of the ulna |
| What muscles are innervated by the radial nerve (C5-T1)? | anconeus, triceps brachii |
| What muscles extend the elbow? | anconeus, triceps brachii |
| Where does the brachialis originate? | on the anterior lower humeral shaft |
| Where does the brachialis insert? | on the coronoid process and the tuberosity of the ulna |
| What innervates the brachialis? | musculocutaneous nerve (C5-C6) |
| Where does the triceps originate? | long head: infraglenoid tuberclelateral head: upper half, posterior humeral shaftmedial head: lower half, posterior humeral shaft |
| Where does the triceps insert? | olecranon process |
| What forms the superior border of the cubital fossa? | line between the lateral and medial epicondyles |
| What forms the lateral border of the cubital fossa? | the brachioradialis |
| What forms the medial border of the cubital fossa? | the pronator teres muscle |
| What important structures are located in the cubital fossa? | brachial artery, deep accompanying veins, median nerve, radial nerve, median cubital vein |
| What nerve is responsible for the biceps reflex? | the musculocutaneous (C5-C6) |
| What can biceps tendonitis be a precursor for and why? | a rotator cuff tear, because of the tendon's location in the bicipital groove |
| What symptoms would a patient have if the tendon of the long head of the biceps was dislocated? | popping or catching with rotation, positive Yergason's test |
| A rupture of the long head of the biceps frequently happens in what location? | proximally, may be treated conservatively |
| If a rupture of the long head of the biceps happens distally, what should be done? | surgery |
| How can the musculocutaneous nerve become injured? | in the axilla |
| If the musculocutaneous nerve is injured, what muscles might be paralyzed? | biceps, coracobrachialis, brachialis |
| Where might there be loss of sensation if the musculocutaneous nerve is injured? | in the area supplied by the lateral antebrachial cutaneous nerve |
| If there is injury to the radial nerve superior to the branch of the triceps, paralysis of what muscles will result? | triceps, brachioradialis, supinator, extensor muscles of wrist and fingers |
| If there is injury to the radial nerve in the radial groove, what symptoms might a patient present with? | wrist drop |
| What are the major ligaments of the elbow joint? | radial collateral, ulnar collateral, annular |
| The anterior compartment of the forearm is involved in what motions? | first of all, it is referred to as anteromedial and contains the flexor and pronator muscles |
| The posterior compartment of the forearm is involved in what motions? | First of all, it is referred to as posterolateral and contains the extensor and supinator muscles |
| The anterior compartment is separated from the extensor muscles by what? | the radius and ulna and interosseous membrane |
| What holds the flexor pronator muscles in place at the wrist? | by flexor retinaculum (transverse carpal ligament) |
| What holds the extensor and supinator muscles in place? | The extensor retinaculum |
| What are the 3 layers of the anterior compartment of the forearm? | superficial, intermediate, deep |
| What muscles make up the superficial layer of the anterior compartment of the forearm? | pronator teres, flexor carpi ulnaris, palmaris longus, flexor carpi ulnaris |
| What muscles make up the intermediate layer of the anterior compartment of the forearm? | flexor digitorum superficialis |
| What muscles make up the deep layer of the anterior compartment of the forearm? | flexor digitorum profundus, flexor pollicis longus, pronator quadratus |
| What important nerves are involved in the anterior compartment? | median, anterior interosseous (from median), and ulnar nerves |
| What muscles are involved in the posterior compartment of the forearm? | brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, extensor pollicis brevis, extensor pollicis longus, extensor digitorum, extensor indicis, extensor digiti minimi |
| What nerves are involved in the posterior compartment of the forearm? | radial/posterior interosseous nerve |
| Name the extensors of the wrist. | extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris |
| Name the extensors of the thumb. | extensor pollicis brevis, extensor pollicis longus |
| Name the extensors of the fingers. | extensor digitorum, extensor indicis, extensor digiti minimi |
| Where do the lumbricals insert? | on the lateral (radial) sides of the extensor expansions of fingers 2 to 5 |
| What do the lumbricals do? | they are chiefly flexors of the MCP joints and extensors at the interphalangeal joints |
| what do the intereossei muscles do? | they abduct and adduct the fingers |
| Where is the ulnar artery located? | lies lateral to ulnar nerve in Guyton's canal |
| What are the branches of the ulnar artery? | superficial palmar arch, deep palmar arch |
| The superficial palmar arch is further divided into what? | common palmar digital, proper palmar digitals |
| Describe the path of the radial artery. | crosses the anatomical snuffbox and becomes the princeps pollicis artery to the thumb, it ends by anastomosing with the deep palmar branch of the ulnar artery to form the deep plantar arch |
| What is the principle nerve of the anterior compartment of the forearm? | median nerve |
| What does the median nerve innervate? | all flexors except the FCU and ulnar half of the FDP, the thenar muscles except the adductor pollicis and deep head of the FPB, radial 2 lumbricals, sensation of palmar and dorsal skin of radial 3.5 digits and palm |
| What are the branches of the median nerve? | anterior interosseous (pronator quadratus), palmar cutaneous branch (central palm), |
| How does the median nerve enter the hand? | through the carpal tunnel through the recurrent branch of the median nerve |
| The ulnar nerve supplies what muscles? | only 1.5 muscles in the forearm (FCU and ulnar half of the FDP), in the hand it provides sensation and motor to small muscles |
| What branches of the ulnar nerve are involved in providing sensation and motor to small muscles of the hand? | palmar cutaneous branch, dorsal cutaneous branch, deep branch |
| Where does the palmar cutenous branch go? | on the ulnar palm |
| Where does the dorsal cutanous branch go? | ulnar half dorsum of the hand, small finger, ulnar half of ring finger |
| The deep branch of the sensation and motor branch innervate what muscles? | hypothenar muscles, ulnar two lumbricals, adductor pollicis, deep head of FPB, interossei |
| Describe the path of the radial nerve in the forearm. | it supplies sensation and motor through the superficial radial (sensation), and the deep branch of the radial nerve (aka. posterior interosseous)--->all muscles located entirely in posterior compartment of forearm distal to lateral epicondyle |
| Describe the path of the radial nerve in the hand. | it provides sensation only through the superficial branch of the radial nerve to the radial 2/3 dorsum of the hand, dorsum of thumb, proximal radial one and a half digits |
| Describe the motor supply to the median nerve | all flexors except FDP to 4 and 5, pronator teres, palmaris longus, abductor pollicis brevis, opponens pollicis, flexor pollicis brevis (the superifical head), radial two lumbricals |
| Describe the motor supply of the ulnar nerve. | flexor digitorum profundus to 4 and 5, adductor pollicis, abductor digiti minimi, opponens digiti minimi, flexor digit minimi, flexor pollicis brevis (deep head), interossei, ulnar two lumbricals |
| Describe the motor supply of the radial nerve. | brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum, extensor digiti minimi, supinator, abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis, extensor indicis |
| How are the flexor digitorum profundus and the flexor digitorum superficialis related? | the flexor digitorum profundus splits the flexor digitorum superficialis |
| Where does the FDS insert? | on the middle phalanx |
| Where does the FDP insert? | on the distal phalanx |
| What is the connective tissue on tendon sheath that provides blood supply to tendons? | vincula |
| Describe the path of the FDS and FDP through their respective bursae | the FDS and FDP enter the ulnar bursa (common flexor sheath) then enter the respective digital synovial sheaths |
| The FPL enters what bursa? | the radial bursa |
| What fascia is continous with the antebrachial fascia? | palmar fascia |
| When the palmaris longus tendon is present, what is the expanded tendon of the palmaris longus? | palmar aponeurosis |
| What is the initial pathology involved in Dupuytren's contracture? | painless nodular thickenings of the palmar aponeurosis that adhere to the skin. |
| How can Dupuytren's contracture progess to something worse? | Progressive contracture of the longitudinal bands produces raised ridges in the palmar skin that extend from the proximal part of the hand to the base of the 4th and 5th fingers |
| DeQuervain's tenosynovities involves the tendons of what muscles? | muscles in the dorsal compartment, such as the APL and EPB |
| What are some symptoms of DeQuervain Tenosynovitis? | pain over the radial side of the wrist radiating distal into the thumb |
| What is trigger finger? | A snapping condition of any of the digits of the hand when opened or closed |
| What is the pathogology behind claw hand? | extension of the MCP joint and flexion of the PIP and DIP joints from pathology the ulnar nerve. |
| What is Ape hand? | inability to oppose the thumb and limited abduction of the tongue from damage that |
| The median nerve supplies sensory fxn to what parts of the body? | the thumb, index, middle and radial half of the ring finger on the palmar side of the hand and the tip of the thumb, index, middle and ring finger on the dorsum of the thumb |
| The radial nerve supplies sensory fxn to what parts of the body? | the dorsolateral aspect of the hand and the dorsal aspect of the thumb, index, middle, and lateral half of the ring fingers |
| The ulnar nerve supplies sensory fxn to what parts of the body? | the dorsal and palmar aspects of the medial half of the ring finger and the whole of the little finger. |
| How do you assess the motor fxn of the median nerve? | ask the patient to make an O |
| How do you assess the motor fxn of the radial nerve? | ask the patient to straighten their fingers |
| How do you assess the motor fxn of the ulnar nerve? | ask the patient to spread their fingers |
| How do assess the vascular fxn in the forearm and wrist? | examine radial and ulnar pulse, assess capillary refill |
| What do you want to do as part of your initial assessment of an injury to the forearm and/or wrist? | ABC, neurovascular fxn, examine for tenderness and ROM, perform a complete exam for other injuries, immobilize the forearm and upper arm while waiting for an X-ray, provide analgesia, immediate fx reduction if there is neurovascular compromise |
| What is the MOI of adult two bone forearm fxs? | MVAs, direct blow, fall from a height or during a sport |
| What is the usual presentation of an adult two bone forearm fx? | pain and swelling at site, obvious deformity |
| What type of X-rays do you need to assess an adult two bone forearm fx? | X-ray entire length of forearm, wrist and elbow, with AP and lateral views |
| What is the usual treatment for adult two bone forearm fxs? | operative treatment due to displacement |
| What are some complications of forearm fxs? | nonunion/malunion, compromise of brachial/radial artery blood supply, median, ulnar, or radial nerve injury, infection (most likely if fx is secondary to cruch injury), compartment syndrome, radioulnar fusion (synostosis), refx |
| What is an essex-lopresti lesion? | a comminuted radial head fx, longitudinal radioulnar dissociation may result if the forearm interosseous ligament tears as well |
| What are some examples of distal radius fxs? | colles, smiths, bartons, chauffeurs |
| What is the most common MOI for distal radial fxs? | fall on an outstretched hand |
| What is the etiology behind lateral epicondylitis? | any activity involving wrist extension and/or supination |
| What are some risk factors associated with work-related lateral epicondylitis? | handling tools heavier than 1 kg, handling loads heavier than 20 kg at least 10 times a day, and repetitive movements for more than 2 hours per day |
| What is the pathophysiology associated with lateral epicondylitis? | it is an inflammatory process of the radial humeral bursa, synovium, periosteum, and the annular ligament, microscopic tearing results with formation of reparative tissue in the origin of the extensor carpi radialis brevis (ECRB) |
| What is the typical patient presentation with lateral epicondylitis? | patient presents with lateral elbow and forearm pain exacerbated by use, typical patient is a man or woman aged 35-55 who is a recreational athlete or one who engages in rigorous daily activities |
| What might you find on examination of a patient with lateral epicondylitis? | the point of maximal tenderness is just distal (5-10 mm) to the lateral epicondyle in the area of the extensor carpi radialis brevis muscle, wrist extension or supination against resistance with the elbow extended should provoke the patient's symptoms. |
| What is the usual treatment for lateral epicondylitis? | usually non surgical, unless the patient is unresponsive after 6 months |
| How is the pronator syndrome related to the median nerve? | it is the most proximal entrapment neuropathy of the median nerve |
| What are some symptoms of pronator syndrome? | pain in the proximal volar surface of the distal arm and forearm which generally increases with activity, decreased sensation in the radial 3 and one-half digits, negative phalen's |
| How do you test for pronator syndrome? | by holding F/A in resisted pronation and flexion and then gradually extend it in the pronated position |
| What causes the pronator syndrome? | compression between the heads of the pronator teres |
| What is typically helpful in working up a pronator teres patient? | EMG and NCV studies |
| What is the treatment for pronator syndrome? | surgical decompression |
| What is another name for radial tunnel syndrome? | recalcitrant tennis elbow |
| What characterizes radial tunnel syndrome? | pain over the anterolateral proximal forearm in the region of the radial neck |
| What subgroup of people are particularly predisposed to developing radial tunnel syndrome? | individuals whose work requires repetitive elbow extension or forearm rotation |
| Where are the symptoms reproduced in radial tunnel syndrome? | the maximum tenderness is located 4 fingerbreadths distal to the lateral epicondyle, symptoms are reproduced by extending the elbow and pronating the forearm, resisted active supination and extension of the long finger also cause pain |
| How do you differentiate between lateral epicondylitis and radial tunnel syndrome? | with lateral epicondylitis, the tenderness is usually directly over the epicondyle and not 4 fingerbreadths distal to it. |
| When is surgery for radial tunnel syndrome warranted? | if conservative treatment fails after 12 weeks |
| What is the 2nd most common compressive neuropathy? | cubital tunnel syndrome |
| Which gender is most predisposed to cubital tunnel syndrome? | males |
| What are signs of cubital tunnel syndrome? | numbness and tingling along the little finger and ulnar half of the ring finger, usually accompanied by weakness of grip, this usually occurs when the patient rest upon or flexes the elbow |
| Where is the pain located in cubital tunnel syndrome? | at the level of the cubital tunnel, which may radiate proximally or distally, symptoms vary from a vague discomfort to hypersensitivity at the elbow, and they may be intermittent at first and then become constant |
| What might be quite disturbing to a patient with cubital tunnel syndrome? | nocturnal symptoms, especially with elbow flexion |
| Patients with chronic ulnar neuropathy may complain of what? | loss of grip and pinch strength and loss of fine dexterity |
| Patients with severe prolonged compression may complain of what? | instrinsic muscle wasting and clawing or abduction of the little finger |
| What is the treatment for cubital tunnel syndrome? | night splints, modification of activity, NSAIDS, surgical decompression |
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bmensen
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