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Clinical Correlations for Anatomy Test 1


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Fracture of clavicle
- fall on shoulder or outstretched hand or birthing
- 1/2 or lateral 1/3 weakest
- SCM pulls proximal up
- deltoid, trap, gravity pull distal down
- cause injury to brachial plexus (lower trunk)
- MBC and MABC region cause parethesia in skin (C8-T1)
- cause fatal hemorrhage from subclavian vein
what can happen to superior transverse scapular ligament? effects?
- could calcify
- trap and compress suprascapular nerve, which passes thru scapular notch under ligament
- affect function of supraspinatus and infraspinatus
Fracture of greater tuberosity
- from direct trauma or violent contraction of supraspinatus
- attachments for suprasp, infraspinatus, teres minor (rotator cuff muscles)
Fracture of lesser tuberosity
- accompanies posterior dislocation of shoulder joint
- insertion point for subscapularis (rotator cuff)
Fracture of surgical neck
- common in elderly w/ osteo.
- from minor fall on hand
- injure axillary nerve and posterior humoral circumflex artery
- found in quadrangular space
Fracture of humerus shaft
- may injure radial nerve and profunda brachii which is found in radial groove
Fracture of medial epicondyle
- may damage the ulnar nerve
- nerve may be compressed in groove behind medial epicondyle funny bone
causes numbness
Supracondylar fractures
- common in children when fall on outstretched hand with elbow partially flexed
- injure median nerve
Colles' fracture of wrist
- fracture of lower end of radius
- distal fragment displaced posteriorly
- dinner fork deformity
- know of Smith's fracture
Smith's fracture
- reverse Colles' fracture
- distal fragment is displaced anteriorly
Fracture of scaphoid
- from fall on outstretched hand
- pain during dorsiflexion and abduction
- may damage radial artery
- cause avascular necrosis of bone and degernative joint disease of wrist b/c of poor blood supply
Severe crushing injuries of hand
- produce multiple metacarpal fractures, instability of hand
fracture of distal phalanx
- usually comminuted
- painful hematoma develops
- from crushing injury
Fracture of hamate
- may injure ulnar nerve and artery which are in close proximity to hook of hamate
- ulnar artery and nerve may be compressed in Guyon's canal
Bennet's fracture
- fracture of the base of the metacarpal of the thumb
Boxer's fracture
- fracture of the necks of the 2nd and 3rd metacarpals, seen in professional boxers
- unskilled boxers: typically in 5th metacarpal
Dislocation of AV joint
- results from fall on shoulder, impact on acromion
- called a shoulder separation
- shoulder separated from clavicle
- rupture of coracoclavicular ligament
inferior dislocation of humerus
- not uncommon because inferior aspect of shoulder joint not supported by tendons of rotator cuff
- may damage axillary nerve and posterior humeral circumflex artery
Referred pain to the shoulder
- probably indicates involvement of phrenic nerve (or diaphragm)
- suprascapular nerve (C3-C4), supplies sneosyr fibers over shoulder has same origin as phrenic (C3-C5)
Rupture of rotator cuff
- occur by chronic wear and tear or acute fall
- causes severe limitation of shoulder joint motion, chiefly abduction
- degenerative inflammatory changes (tendonitis)of rotator cuff
- subacromial bursitis: attrition of supraspinatus tendon leads to open communication between shoulder joint cavity and subacromial bursa --> painful shoulder

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