Glossary of Block 1 - Gross - Clinical
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- Strength of Sternoclavicular Joint?
- Extremely strong, rarely tear
- What is a shoulder separation?
- Tear at the Acromioclavicular Joint or more commonly at the coracoclavicular joint
- What is the most fractured bone?
- Where does the clavicle usually break?
- Lateral 1/3, concave area
- What is the only bony attachment between the shoulder girdle and the axial skeleton?
- Sternoclavicular Joint
- What are the most common anatomical areas of complaint?
- Upper limb and Lower back strain
- What is the source of most lower back pain?
- Muscle strain of the Deep Muscles of the back
- Vertebral Column
- Convex posterior curvature of vertebral column; Most common is thoracic region in elderly women due to osteoporosis
- Increase in lumbar curvature; Reversible; Common in pregnant females and obesity
- Non-vertical curvature; Most common abnormal curvature
- What commonly occurs when a neck is broken?
- Crush the dens of C2 (Axis) vertebra into the spinal ; cord; Damages C3; C4 controls diaphragm (respiration); Christopher Reeve-Horse accident; Diving accident
- What prevents hyperextension of the vertebral column?
- Anterior Longitudinal Ligament
- What is the most common cause of hyperextension?
- What prevents hyperflexion of the vertebral column?
- Posterior Longitudinal Ligament
- What is an intervertebral disc herniation?
- Protrusion of the Nucleus Pulposus
- Describe why Intervertebral Disc Herniation occurs posterolaterally?
- Posterolateral rupture of the IV Disc due to thin Posterior Longitudinal Ligament that covers only the center of the posterior vertebral body
- What causes Posterolateral IV disc herniation?
- Flexion; Dorsal pressure on the intervertebral disc
- Most common IV Disc Herniations? Presenting pain?
- L4/L5 or L5/S1; Sciatica; Anything that would stretch the sciatic nerve exacerbates the pain that runs down the thigh and leg
- What causes arthritic pain in the back?
- Zygopophyseal joints; (Osteoarthritis)
- What is the sensory innervation to the zygopophyseal joints?
- Dorsal Rami of the Spinal Nerves
- Where is the ligamenta flava located?
- Between the lamina of the vertebral column
- How are IV discs counted?
- By the vertebral body above
- If a patient has an L3 herniated disc what nerve is compressed?
(Because L3 has already left the vertebral foramen)
- If a patient has an C3 herniated disc what nerve is compressed?
(Because C4 exits the vertebral foramen above C4 vertebral body at the C3 disc)
- What is found in the Epidural space that is clinically significant concerning cancer? Why?
- Internal Vertebral Venous Plexus (Cancer spread occurs here because the plexus has no valves; Secondary brain cancer from prostate cancer
- If someone turns their head and experiences dizziness or light-headedness what could be the cause?
- Arteriosclerosis (Harding of Arteries)
Decreases blood flow to the head through vertebral arteries
- What acts to pressurize the subarachnoid space?
- Cerebral Spinal Fluid
- Where are lumbar punctures preformed?
- L3/L4 or L4/L5
- Why are lumbar punctures performed?
- Retrieve cerebral spinal fluid for diagnostic purposes
- What pops when performing a lumbar puncture?
- Ligamenta Flava
- What is used to determine L4 area?
- Illiac Crest
- Upper Limb
- The most common fracture of the Humerus is where?
- Surgical Neck of the Humerus
- What protects the glenohumeral joint superiorly?
- Describe the capsule of the glenohumeral joint?
- Loose (sacrifice stability for increased mobility)
- What stabilizes the glenohumeral joint or most joints?
- Muscles, Rotator Cuff SitS
- What do you do to test medial and lateral rotation of the Humerus?
- Have patient flex elbow, rotate toward and away from chest
- What occurs most common in a shoulder dislocation?
- Anatomical Neck dislocates from the glenoid cavity inferiorly due to lack of support (no muscle inferior to joint)
- What occurs in a rotator cuff injury?
- Wear out the Supraspinatus or subacromial bursa; Tear of Supraspinatus requires surgery
- Nervous System
- When testing nerve innervation what is important to test?
- Sensory and Motor
- What is the basic dermatome layout of the upper limb (from shoulder to hand to axilla)?
- C5, C6, C7 (middle of the hand), C8, T1
- What types of nerve fibers are found in cutaneous nerves?
- GSA, GVA, GVE
- What is very susceptible to injury in the medial aspect of arm?
- Neurovascular bundle: Brachial Artery
- If the radial nerve is injured distal to the radial groove, is there any loss in extension of the forearm?
- Lymphatic System
- What part of the body does the Thoracic Duct drain?
- Entire left side and right side below the diaphragm
- What drains the rest of the body?
- Right Lymphatic Duct
- Mammary Glands
- What ligaments support the mammary glands?
- Cooper's Ligaments
- Why is this significant in cancer detection?
- Breast cancer pulls at these ligaments causing dimpling of the breasts
- Where does most of the lymphatic drainage collect from the breast?
- Lateral Pectoral Nodes; The rest goes to the Parasternal Nodes
- What can spread cancer between the breasts?
- Cutaneous lymphatics
- What is Thoracic Syndrome?
- Possessing a cervical rib
- What causes winged scapula?
- Laceration of the Long Thoracic Nerve
- What must a surgeon be careful to miss when performing a masectomy?
- Long Thoracic Nerve
- What arteries provide collateral circulation around the scapula?
- Dorsal Scapular Artery,
Circumflex Scapular Artery
- Syndromes and Nerve Lesions of the Upper Limb
- What is the common injury that occurs when a person's neck and shoulder is severely separated?
- Erb's (Duchanne) Palsy; Waiter's Tip
- What nerves are injured?
- C5 and C6 Ventral Rami at the roots of the Brachial Plexus
- What is a common cause of this injury?
- Birth or a fall (off a horse or motorcycle)
- What Nerves are affected?
- Suprascapular N.
- What muscles are lost?
- Supraspinatus M.
Biceps Brachii M.
Teres Minor M.
- What is person's physical presentation of Erb's Duchanne Palsy (Waiter's Tip)?
- Upper limb medially rotated
Upper limb strongly adducted
- What are the main antagonists causing this presentation?
- Latissimus Dorsi
- What sensory loss would occur with Erb's Palsy?
- Shoulder (Axillary N.); Lateral Forearm (Musculocutaneous N)
- What occurs with the loss of the Long Thoracic Nerve?
- Winged Scapula
- What muscle is paralyzed in Winged Scapula?
- Serratus Anterior
- What is Dupuytren's Contracture?
- What is the common injury resulting from damage to the lower roots of the brachial plexus?
- Klumpke's Palsy
- What nerve is most affected in Klumpke's?
- Ulnar Nerve
- What are the presenting factors from Klumpke's?
- Weakness in wrist flexion (FCU Muscle); Impaired digital Movements; Sensory loss to Medial Brachial and Antebrachial Cutaneous Nerves and lateral 1.5 digits
- What is the result of an injured Radial Nerve in the distal radial groove?
- Wrist Drop; Loss of all muscles in extensor compartment innervated by Radial Nerve or its branches
- With wrist drop what extension is still possible?
- Extension at the DIP and PIP joints due to intact lumbrical and Interosseous muscles
- What causes claw hand?
- Injury of Ulnar Nerve at the wrist
- What is the result of an injured Ulnar Nerve at the wrist?
- Thumb strongly abducted
MP joints hyperextended
MP extension more pronounced in digits 4,5
DIP and PIP joints flexed
4, 5 more flexed due to lumbrical loss
- What decreases the amount of clawing in digits 4 and 5?
- More proximal lesion to Ulnar Nerve; Knock out FDP causing flexion of 4 and 5
- The more distal the lesion . . . . .
- The greater the clawing
- Can the patient with claw hand abduct fingers?
- Adduct fingers?
- What results from damage to the median nerve at the wrist proximal to the flexor retinaculum?
- Ape Hand; Loss of opposition and normal grasping; Adductor Pollicis pulls thumb into flat ; plane of the hand; Weakness in MP flexion and IP extension of digits 2 and 3 due to lumbrical loss; Sensory loss on hand from median
- During surgery of the Thenar Eminence what should you look out for?
- Recurrent Branch of the Median Nerve
- What happens to infections of the palm?
- Forced dorsal due to tight palmar Aponeurosis, plus most venous and lymphatic drainage occur on the dorsum of the hand
- What structures in the palm increases the spread of infection?
- Ulnar and Radial Bursa
- What carpal bone is broken most often?
- Why is this of concern?
- Blood supply is distal to proximal
When fractured, it can die and necrose due to loss of blood supply
- Does nerve entrapment effect the muscle causing the entrapment?
- No, because the nerve innervates the muscle before passing through it
- Where can nerve entrapment occur in the arm?
- Coracobrachialis : Musculocutaneous Nerve
- What would this cause?
- No loss to Coracobrachialis action; Weakness found in flexion and supination of forearm
- Where can nerve entrapment occur in the extensor compartment of the forearm?
- Supinator: Deep Radial Nerve; No loss to Supinator; Weakness in extension due to loss of all muscles innervated by Posterior Interosseous Nerve
- What nerve entrapment can occur in the flexor compartment of the forearm?
- Pronator Teres: Median Nerve; No loss to Pronator Teres; Weakness in flexion and pronation (Pronator quadratus); Weakness in thenar compartment and lateral 2 lumbricals
- Injury to the wrist: What is in danger?
- Name what is just lateral to:
- Flexor Carpi Ulnaris
- Ulnar Nerve and Ulnar Artery
- Palmaris Longus
- Median Nerve
- Flexor Carpi Radialis
- Radial Artery
- Name 2 palpable sternal landmarks.
- Sternal Angle (2nd costal cartilage) T4 vert.
Xyphoid Process –level of the apex of heart
- When inserting a needle between the intercostal spaces where should the needle be inserted?
- What is it called when air enters the pleural space of the lungs?
- What recesses are found in the pleura of the lungs?
- Costomediastinal Recess
- What is the location of the costomediastinal recess?
6 – 8 Intercostal Spaces
(left is larger due to cardiac notch)
- Location of the costodiaphragmatic recess?
- Midaxillary 8 – 10 Intercostal Space
Posterior 10 – 12 intercostal Space
- What is it called when blood enters the pontential space of the pericardium between the visceral and pariental serous layers?
- Cardiac Tampenod
- What is the fossa ovalis?
- Remains of the embryologic Foreman Ovalis
- What occurs if foramen still exits?
- Murmur – deoxygenated blood entering systemic circulation
- Where is the SA node located?
- Base of SVC at cranial end of terminal crest
- Where is the AV node located?
- Septal wall near opening of coronary sinus
- What is the action of the inner cardiac muscles? (Outer)
- Squeeze (Twist)
- Cardiac Ascultation
- Aortic Valve?
- Right 2nd intercostal space
- Pulomonary Trunk valve?
- Left 2nd intercostal space
- Tricuspid valve?
- Left 5th intercostal space (parasternal)
- Mitral (Bicuspid) Valve?
- Left 5th intercostal space (3 inches left)
- Posterior Mediastinum
- What is esophageal varicies?
- Swelling of the esophageal veins due to blockage of the IVC
Causes degradation of the esophagus
- What vertebral level is the aortic hiatus, INV hiatus, esophageal hiatus?
- T12, T8, T10
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