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?
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,
Suprascapular 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.
Musculocutaneous N.
Axillary N.
What muscles are lost?
Supraspinatus M.
Infraspinatus M.
Coracobrachialis M.
Biceps Brachii M.
Brachialis M.
Teres Minor M.
Deltoid M.
What is person's physical presentation of Erb's Duchanne Palsy (Waiter's Tip)?
Upper limb medially rotated
Upper limb strongly adducted
Extended Elbow
Forearm Pronated
What are the main antagonists causing this presentation?
Latissimus Dorsi
Tiiceps Brachii
Pronator Teres
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
Costodiaphragmatic 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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