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WEEK 24:
Introduction to the upper limb - III clinical relevance:
| Question | Answer |
|---|---|
| dislocation of the shoulder joint is named anterior or posterior based on | relation to infraglenoid tubercle |
| ligaments in shoulder joint (4) | glenohumeral (within capsule), coracohumeral, transverse humeral ligament, and coracoacromial arch (and ligament) |
| shoulder joint | ball and socket joint (synovial type joint) which is very mobile but unstable |
| thrust of humerus will result in | fracture humerus shaft/ clavicle first |
| rotator cuff muscles role | during arm movements these contract and prevent the sliding of head of humerus providing stability and help in the mobility of the shoulder joint (abduction, medial and lateral rotation) |
| dislocation can occur through (3) | hard blow to humerus with abducted shoulder joint, excessive extension and lateral rotation of humerus, subsequently 'pull of flexor and abductor' muscles of shoulder joint - humeral head in subcoracoid position |
| during dislocation what else can be damaged | axillary nerve may be damaged as its very close to joint as well as muscles around eg pectoralis major and deltoid |
| type of joint in elbow joint | hinge synovial joint |
| elbow joint capsule strength | weak anteriorly and posteriorly |
| function of elbow collateral ligaments | strong, providing a lot of support |
| ulnar collateral ligament | attaches to medial epicondyle of humerus and ulna's coronoid and olecranon processes |
| radial collateral ligament | fuses with annular ligament of radius and attaches to lateral epicondyle of humerus |
| posterior elbow dislocation occurs in (2) | children FOOSH injuries (radius and ulna dislocate posteriorly and distal end of humerus driven anteriorly through weak an part of joint capsule), and hyperextension |
| student elbow | bursitis of olecranon bursa due to friction/ pressure |
| bursa | small fluid filled sac lined with a thin synovial membrane with main purpose to reduce friction between moving structures |
| proximal radioulnar joint | pivot synovial joint between head of radius and radial notch |
| anular ligament | surrounds radial head as a collar and attaches to ulna and holds head of radius to allow pronation/ supination |
| type of joint in radiocarpal joint (wrist joint) | condyloid synovial joint |
| distal radioulnar joint (wrist joint) | stabilises the radius around the stationary ulna during pronation and supination |
| what separates the radio-ulnar joint from the wrist joint and radius from ulna | fibrous articular disc |
| fracture at surgical neck of the humerus can lead to | axillary nerve damage |
| axillary nerve innervates what muscles (2) | deltoid and teres minor |
| radial nerve innervates what muscles | triceps and muscles in posterior compartment of forearm |
| fracture in region of radial groove | can damage radial nerve |
| when can triceps be weakened | if only medial head affected |
| long head of triceps is innervated by which medial branch | more proximal branch |
| lateral head of triceps is innervated by which medial branch | high in the arm |
| medial head of triceps is innervated by which medial branch | more distal branch |
| fracture in region of medial epicondyle | ulnar nerve at risk |
| annular ligament and head of radius | commonly when swinging children/ pull arm/forearm, pulling up quick to prevent falling in 1-4yrs because their annular ligament is thin and loose and radial head is not fully developed and more conical |
| rotator cuff injuries | common - especially supraspinatus |
| colles fracture | fracture of distal end of radius |
| sublaxation aka | partial loss of contact |
| fracture of scaphoid | can lead to necrosis |
| rupture of supraspinatus tendon | common - where supraspinatus tendon has a poor blood supply and is susceptible to inflammation resulting in degenerative tendinitis or tear |
| painful arc syndrome | shoulder pain when arm is raised above shoulder level |
| calcific supraspinatus tendinitis | calcium deposits in tendon resulting in inflammation |
| compression of median nerve | leads to paralysis of thenar and first 2 lumbricals, opposition of thumb is lost, fine control movement of 2nd and 3rd digits are impaired, and loss of sensation over thumb and adjacent two and a half fingers (cant grab paper) |
| sensory effects of carpel tunnel syndrome | tingling and loss of sensation in lateral 3.5 digits |
| carpel tunnel syndrome leads to | wasting of thenar eminence, unable to oppose thumb, progressive loss of thumb motor function, sensory effects (tingling and loss of sensation in lateral 3.5 digits), and ape hand |
| what happens normally with lumbricals and interosseous muscles | they simultaneously flex the MCP joint while extending the IP joints |
| hand of benediction | caused by median nerve injury (proximal median nerve) where extension of thumb, index and middle finger (gun hand) when trying to make a fist |
| allen's test observes what | tests for adequate anastomoses between radial and ulnar arteries |
| palmar wounds | dangerous because there are numeral branches in the hand (and forearm) leading to a lot of bleeding so may need to compress brachial artery proximal to elbow for surgery on the hand |
| raynauds disease | when blood vessels go into a temporary spasm and bilateral episodes of ischaemia of the digits occur leading to cyanosis, numbness and pain (with an unknown cause but thought to be stress and cold temperature triggered) |
| biceps tendon jerk controlled by | C5, 6 |
| triceps tendon jerk controlled by | C7, 8 |
| superficial branch of radial nerve is what | sensory |
| function of elbow joint | flexion and extension |
| articulations of the elbow joint | humerus (trochlea and capitulum) and ulna (trochlear notch) and radius (concave superior aspect of head) |
| what could possibly be injured during a posterior dislocation of the elbow joint | ulnar nerve |
| what happens to elbow joints during a posterior dislocation in children | radius and ulna dislocate posteriorly and distal end of humerus driven anteriorly through weak part of joint capsule |
| annular ligament function | holds head of radius to allow pronation and supination |
| in rupture of supraspinatus tendon, pain is felt when | 50-130 degrees of abduction (when supraspinatus tendon in contact with acromion) |
| rupture of biceps brachii tendon appearance when flexing elbow | prominent bulge (popeye sign) |
| ape hand - due to carpel tunnel syndrome | thumb can only flex and extend, inability to oppose and limited abduction of thumb |
| wrist drop | caused by radial nerve injury where loss of elbow, wrist and digits extension and decrease in grip strength |
| claw hand | caused by ulnar nerve injury where hyperextension of digits and flexion of ring and pinky finger when at rest |
| patients exhibiting an ulnar claw | frequently unable to abduct or adduct fingers against resistance because ulnar nerve also innervates palmar and dorsal interossei of hand |
| how to conduct the allen's test | compress both radial and ulnar arteries at wrist (make hand go white) and release pressure from one or the other and determine the filling pattern of the hand |
| raynauds disease leads to | cyanosis, numbness and pain |
| shoulder abduction and lateral rotation is controlled by | C5 |
| shoulder adduction and medial rotation is controlled by | C6, 7, 8 |
| elbow flexion is controlled by | C5, 6 |
| elbow extension is controlled by | C7, 8 |
| forearm pronation is controlled by | C7, 8 |
| forearm supination is controlled by | C6 |
| wrist flexion is controlled by | C6, 7 |
| wrist extension is caused by | C6, 7 |
| flexion of long muscles to fingers is controlled by | C7, 8 |
| extension of long muscles to fingers is controlled by | C7, 8 |
| types of tendon jerks | biceps and triceps |
| radial nerve enters hand after passing over | anatomical snuff box and continues into hand to innervate skin on posterolateral surface (back of hand) |
Created by:
kablooey
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