Anatomy Upper Extremities
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- What does a "popeye" muscle indicate?
- a proximal rupture of the long head of the bicep
- What does scapular winging indicate?
- serratus anterior injury due to long thoracic nerve injury
- What does a "piano key" sign or "tenting" indicate?
- acromioclavicular separation or clavical fracture
- What are some tests that can be done to evaluate for impingement syndrome?
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⬢ impingement sign: passive forward flexion; (+) pain > 90º
⬢ Hawkins Test: passive forward flex to 90º and internal rotation; pain = impingement syndrome - What is the apprehension test?
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⬢ abduction to 90º and external rotation
⬢ positive apprehension test = anterior shoulder instability - What is the difference between the anatomical and surgical neck?
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⬢ the anatomical neck is directly distal to the head of the humerus
⬢ the surgical neck is distal to the anatomical neck, below the greater and lesser tubercles - The olecranon is a part of which bone?
- ulna
- What is the treatment for shoulder dislocation?
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⬢ closed reduction
⬢ immobilization in internal rotation - List 5 types of closed reduction
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⬢ stimson maneuver: pt prone on table with weight on arm
⬢ mitch maneuver
⬢ hippocratic maneuver: examiner places sole of foot in axilla
⬢ traction/countertraction
⬢ scapular manipulation: stimson maneuver with medial manipulation of the tip of scapula - What are 2 lesions associated with recurrent shoulder dislocations?
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⬢ Bankhart lesion: anterior capsular injury associated with a tear of the glenoid labrum
⬢ Hill-Sachs lesion: compression fracture of the articular surface of the humeral head - What is the most common bone in the body fractured?
- clavicle
- What is weakest part of the clavicle?
- the junction of the middle and lateral thirds
- Name and describe the 3 classes of clavicle fractures
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⬢ Class A: middle third fracture
⬢ Class B: distal third fracture
⬢ Class C: proximal third fracture - What is the mechanism of injury for AC separation?
- fall onto point of shoulder
- What is the textbook sign for AC separation on physical exam?
- tenderness at the AC junction
- What are bursa?
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⬢ closed, round, flattened sacs that separate bare areas of bone from overlapping muscles (deep bursae) or separate skin and tendon (superficial bursae)
⬢ function to reduce friction and allow a greater range of movement when muscle contracts - What muscles make up the rotator cuff?
- supraspinatus, infraspinatus, teres minor, and subscapularis
- A "waiter's tip" position or Erb-Duchenne palsy is caused by injury to which nerves?
- C5 & C6
- A "claw hand" or Klumpke paralysis is due to injury to which nerves?
- C8-T1
- What is a Yergason test?
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⬢ resisted supination test
⬢ used to test for bicipital tendonitis - Which nerve crosses over the "funny bone"?
- ulnar nerve
- A fracture of the humerus at the surgical neck can injure which nerve?
- axillary nerve
- A fracture of the humerus at the radial groove can injure which nerve?
- radial nerve
- A fracture at the distal end of the humerus can injure which nerve?
- median nerve
- A fracture of the humerus at the medial epicondyle can injure which nerve?
- ulnar nerve
- What is the treatment for midshaft humerus fracture?
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⬢ coaptation splint
⬢ change to Sarmiento brace after 2 weeks - Which part of the humerus articulates with the radial head?
- capitulum
- Which part of the humerus articulates with the ulna?
- trochlea and olecranon fossa
- What is a Nursemaid's elbow?
- subluxation of the radial head from the annular ligament
- What 2 tendons form the snuffbox?
- extensor pollicis brevis tendon and extensor pollicis longus tendon
- What is lateral epicondylitis?
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⬢ pain at the lateral humeral epicondyle, reproduced by extending the wrist against resistance
⬢ aka Tennis elbow
⬢ seen in patients who perform repetitive wrist extension - What is medial epicondylitis?
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⬢ pain at the medial humeral epicondyle
⬢ seen in patients who golf, or perform throwing sports, such as baseball, football, javelin - What is a Die Punch Fracture?
- intra-articular distal radius fracture with impaction of the dorsal aspect of the lunate fossa
- What is the definitive treatment for a scaphoid fracture?
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⬢ long arm thumb spica cast x 4-8 weeks
⬢ if scaphoid is displaced, may require ORIF - What is a Boutonneiere Deformity?
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⬢ a flexed PIP joint & a hyperextended DIP joint
⬢ caused by a central slip of the extensor digitorum communis tendon from its insertion at the dorsal base of the middle phalanx - What is a mallet finger?
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⬢ flexion at the DIP joint & extension or hyperextension at the PIP joint
⬢ caused by a disruption of the extensor tendon over the distal phalanx - What is flexor tenosynovitis?
- infection of the digital synovial sheaths
- What are the 4 classic findings for diagnosis of flexor tenosynovitis?
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⬢ tenderness over flexor tendon sheath
⬢ symmetric swelling of the finger (sausage finger)
⬢ pain with passive extension
⬢ flexed posture of the involved digit at rest - What is trigger finger?
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⬢ a painful condition caused by a narrowing of the sheath that surrounds the finger tendon
⬢ inflamed nodule of tendon gets trapped behind tendon sheath and finger becomes stuck in flexed position - Which muscles allow for abduction and adduction of the hand?
- lumbrical muscles
- What is De Qyervain's Tenosynovitis?
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⬢ an entrapment tendonitis of the tendons contained within the first dorsal compartment at the wrist
⬢ results in pain with thumb motion - What is the Finkelstein test?
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⬢ the most classic finding in De Quervain tenosynovitis is a positive Finkelstein test
⬢ have the patient make a fist with the thumb inside the fingers
⬢ the clinician applies passive ulnar deviation of the wrist to reproduce the chief complaint of dorsolateral wrist pain - What is paronychia?
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⬢ a superficial infection of the epithelium lateral to the nail plate
⬢ most frequently caused by staphylococci - What is a felon?
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⬢ closed-space infections of the fingertip pulp
⬢ infection occuring within these fingertip pulp compartments can lead to abscess formation, edema, and increased pressure in a closed space
⬢ can compromise blood flow and lead to necrosis of the skin and pulp - What is Herpetic Whitlow?
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⬢ an intense, painful skin infection caused by the herpes simplex virus
⬢ tiny fluid-filled blebs (vesicles) on the fingers
⬢ fingertip is sore and swollen but is not as firmas in a felon - What parts of the hand does the radial nerve innervate?
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⬢ sensation to the dorsum of the hand on the radial side
⬢ sensation 3rd metacarpal, dorsal thumb, index, and middle fingers as far as the distal phalanges
⬢ evaluate motor by testing thumb extension (hitchhiking) - What part of the hand does the ulnar nerve innervate?
- - sensation to the ulnar side of hand (dorsal & palmar) of the pinkie and half of the ring finger
- What part of the hand does the median nerve innervate?
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⬢ palmar sufrace of thumb, index, middle and half of ring finger
⬢ may supply dorsum of terminal phalanges of these fingers - What causes Thoracic Outlet Syndrome?
- irritation of C8 and T1
- What does the musculocutaneous nerve innervate?
- the radial side of the forearm
- What is Carpal Tunnel?
- a syndrome characterized by pain, paresthesias, and weakness in the median nerve distribution of the hand
- What are 2 tests used to evaluate for Carpal Tunnel?
- Tinel's test and Phalen's Test
- What is Cubital Tunnel Syndrome?
- pressure on the "funny bone" causing pain, paresthesia to the ulnar nerve distribution
- What is Saturday Night Palsy?
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⬢ injury of the upper arm, usually by sleeping with arm over the back of a chair
⬢ decreased or absent sensation on the radial and dorsal side of hand and wrist and
⬢ inability to extend wrist, thumb, and finger joints
⬢ when the hand is pronated, the wrist and hand will drop