Block 1 - Gross - Clinical

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Back
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?: Clavicle
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
Kyphosis?: Convex posterior curvature of vertebral column; Most common is thoracic region in elderly women due to osteoporosis
Lordosis?: Increase in lumbar curvature; Reversible; Common in pregnant females and obesity
Scoliosis?: 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?: Whiplash
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?: L4
(Because L3 has already left the vertebral foramen)
If a patient has an C3 herniated disc what nerve is compressed?: C4
(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?: Acromion
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?: No
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
Axilla
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?: Shortening
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?: No
Adduct fingers?: No
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
Hand
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
Random
What carpal bone is broken most often?: Scaphoid
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
Thorax
Name 2 palpable sternal landmarks.: Sternal Angle (2nd costal cartilage) T4 vert.
Xyphoid Process â€“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?: Pneumothorax
What recesses are found in the pleura of the lungs?: Costomediastinal Recess
Costodiaphragmatic Recess
What is the location of the costomediastinal recess?: Midclavicular
6 â€“ 8 Intercostal Spaces
(left is larger due to cardiac notch)
Location of the costodiaphragmatic recess?: Midaxillary 8 â€“ 10 Intercostal Space
Posterior 10 â€“ 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 â€“ 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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