Lecture 3 - Clinical anatomy of upper limb

lukemassey's version from 2015-06-13 01:47


Question Answer
Clavicle fracturePatient lifts arm up to realign. Sternocleidomastoid pulls up, gravity pulls down.
Conoid/trapezoid ligament injuryAcromioclavicular joint injury. Requires surgery. Serious.
Anteriorly dislocated shoulderResults in loss of deltoid curve. Head of humerus under subscapularis.
Axillary nerve lesionFrom reduction of humeral dislocation. Prevent by assessing deltoid anaesthesia.
Supraspinatous lesionPainful arc between 45-90 degrees due to bursitis. Treated via steroids.
Hill Sachs lesionPosterior glenoid fossa compressed during dislocation
Bankart lesionAnterior glenoid fossa (labrum) torn during dislocation


Question Answer
Volkman's ischemic contracture (claw)Fibrosis and necrosis of intrinsic hand muscles. From blocking of brachial artery.
Radial neck fractureReplaced with prosthetic head or removed. Annular ligament opened.
Dislocated elbow (differentiation from fracture)Greater distance from medial epicondyle to olecranon.
Proximal radial fractureLeads to twisting from biceps supinating and teres pronating.
Proximal ulnar realignmentVia casting in flexed and supinated position.
Distal ulnar realignmentVia casting in neutral position.
Radial head fracturesCreate effusion in adults
Supracondylar fracturesCreate effusion in children
Incarcerated fragmentMedial epicondyle moves into elbow joint space


Question Answer
Colles' fractureDistal radius. Leads to dinner fork deformity - radial and dorsal deviation.
Colles' realignmentVia casting in flexed and ulnar deviated position. Free fingers.
Lunate or scaphoid fracture.From a fall on outstretched hand.
Proximal scaphoid fractureSnuff box tenderness. Can lead to avascular necrosis and slcerosis.
Carpal tunnel syndromeParasthesia and pain. Lack of opposition if medial nerve irritated (median nerve palsy).
Treatment of carpal tunnel syndromeSplitting of flexor retinaculum.
Palmar infectionsLead to dorsal swelling
Whitlow's infectionInfection at dorsal pulp space of finger tip.
Colles' fractureDinner fork deformity of wrist. Radiocarpal normally 15 degrees.
Scaphoid nonunion advance collapse (SNAC)Necrosis from scaphoid and radial fracture
Mallet fractureSubluxed finger. Injury to extensor tendon at DIP. Similar to swan neck.
Boutonniere deformityTear in central extensor slip. Raised PIP. 
6 compartments of the extensor retinaculum1) AbPL and EPB 2) ECRL and ECRb 3) EPL 4) ED & EI 5) ECU 6 ) EDMi.


Question Answer
6 Ps of acute ischemiaPallor, pain, paralysis, pulsenessness, parasthesia, poikilothermia.
Intra arterial anaesthesiaLeads to loss of thenar eminence (radial artery) or hypothenar eminence (ulnar artery).
Allen's test for anastomosesFor non-dominant artery. Both occluded, radial let out then ulnar, alternately to see which fills fastest.
PoikilothermiaFluctuating internal temperature
Subclavian artery stenosisLeads to turbulence and thromboembolism to digital arteries --> trashing
Blocked vein in the armLeads to venous congestion and venous thrombosis
TrashingGangrene in fingertips from arterial stenosis
Brachial artery stenosisFrom supracondylar fracture --> Volkman's


Question Answer
Long thoracic nerve lesionParalysed serratus anterior. Scapula moves posteriorly.
Thoracodorsal nerve lesionParalysed latissimus dorsi.
Brachial plexus lesionErb Duchenne paralysis/waiter's/policeman's tip. C5 & C6 issues. Hand pronated, wrist flexed, fingers curled.
T1 root lesionKlumpke's claw. Anaesthesia on medial arm, paralysis of intrinsic hand muscles.
Median nerve lesionLack of opposition. Anaesthesia in thumb through to middle of ring finger (palmar).
Ulnar nerve lesionAnaesthesia on palmar and dorsal surface of pinky and half of ring finger.
Ulnar nerve palsyNo adduction of fingers. Claw.
Radial nerve lesionWrist drop. Anaesthesia in snuff box area.


Question Answer
ApophysesGrowths on bone that do not add to the length.
EpiphysesBone growths that add to the length.