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?: ⬢ 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?: ⬢ abduction to 90º and external rotation
⬢ positive apprehension test = anterior shoulder instability
What is the difference between the anatomical and surgical neck?: ⬢ 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?: ⬢ closed reduction
⬢ immobilization in internal rotation
List 5 types of closed reduction: ⬢ 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?: ⬢ 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: ⬢ 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?: ⬢ 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?: ⬢ 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?: ⬢ 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?: ⬢ 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?: ⬢ 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?: ⬢ long arm thumb spica cast x 4-8 weeks
⬢ if scaphoid is displaced, may require ORIF
What is a Boutonneiere Deformity?: ⬢ 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?: ⬢ 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?: ⬢ 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?: ⬢ 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?: ⬢ 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?: ⬢ 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?: ⬢ a superficial infection of the epithelium lateral to the nail plate
⬢ most frequently caused by staphylococci
What is a felon?: ⬢ 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?: ⬢ 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?: ⬢ 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?: ⬢ 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?: ⬢ 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

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