Clinical Anatomy - Upper Limb (disorders/pathology)

Injuries to inferior parts of the brachial plexus (________ ____________) are much less common. What can cause for inferior brachial plexus to be avulsed? And what spinal nerves affected?

Klumpke paralysis or pulsy Inferior brachial plexus injuries may occur when the upper limb is suddenly pulled superiorly—for example, when a person grasps something to break a fall, or a baby's upper limb is pulled excessively during delivery. These events injur the inferior trunk of the brachial plexus (C8 and T1), and may avulse the roots of the spinal nerves from the spinal cord.

Skier's thumb (historically, game-keeper's thumb) refers to the rupture or chronic laxity of the collateral ligament of the __1___ _________ joint. The injury results from _________2_______ of the __3____ joint of the thumb, which occurs when the thumb is held by the ski pole while the rest of the hand hits the ground or enters the snow. In severe injuries, the head of the metacarpal has an avulsion fracture.

1. 1st MP 2. hyperabduction 3. MP

Most dislocations of the SC joint in persons < __1__ years of age result from fractures through the ______2________ plate because the epiphysis at the sternal end of the clavicle does not close until ____-___ years of age.

1. 25 2. epiphysial 3. 23-25

Muscles and nerves can tolerate up to ___1___ hours of ischemia. After this, fibrous scar tissue replaces necrotic tissue and causes the involved muscles to shorten permanently, producing a flexion deformity, the _____2_____ ____________syndrome.

1. 6 2. ischemic compartment

______1______ dislocation of the glenohumeral joint occurs most often in young adults, particularly athletes. It is usually caused by excessive extension and lateral rotation of the _______2_______. What is the mechanism?

1. Anterior 2. humerus The head of the humerus is driven inferoanteriorly, and the fkbrous layer of the joint capsule and glenoid labrum may be stripped from the anterior aspect of the glenoid cavity in the process

Owing to the poor blood supply to the proximal part of the scaphoid, union of the fractured parts may take at least 3 months. ____1_____ _________ of the proximal fragment of the scaphoid (pathological death of bone, resulting from inadequate blood supply) may occur, and produce degenerative joint disease of the wrist. In some cases, it is necessary to fuse the carpals surgically (_______2_______).

1. Avascular necrosis 2. arthrodesis

As a result of injuries to the superior parts of the brachial plexus (___________1____________), paralysis of the muscles of the shoulder and arm supplied by the C5 and C6 spinal nerves occurs: ____2____, _________, and _________.

1. Erb-Duchenne palsy 2. deltoid, biceps, and brachialis

Power of wrist adduction is impaired in ulnar nerve injury, and when an attempt is made to flex the wrist joint, the hand is drawn to the lateral side by the _______ (supplied by the median nerve) in the absence of the "balance" provided by the _______.

1. FCR 2. FCU

_____1______ syndrome, a nerve entrapment syndrome, is caused by compression of the median nerve near the elbow. The nerve may be compressed between the heads of the ____2______ _________ as a result of trauma, muscular hypertrophy, or fibrous bands. Individuals with this syndrome are first seen clinically with pain and tenderness in the proximal aspect of the anterior forearm, and ________3________ (decreased sensation) of palmar aspects of the radial three and half digits and adjacent palm. Symptoms often follow activities that involve repeated pronation.

1. Pronator 2. pronator teres 3. hypesthesia

The _____1______ atrophies when the axillary nerve (C5 and C6) is severely damaged. Because it passes inferior to the humeral head and winds around the surgical neck of the humerus, the axillary nerve is usually injured during fracture of this part of the humerus. What else can lead to the injury of the axillary nerve?

1. deltoid It may also be damaged during dislocation of the glenohumeral joint, and by compression from the incorrect use of crutches.

Fracture of the ____1_____ end of the radius is a common fracture in adults > 50 years of age, and occurs more frequently in women because their bones are more commonly weakened by _______2_______. A complete transverse fracture of the distal 2 cm of the radius, called a _____3____ fracture, is the most common fracture of the forearm. The distal fragment is displaced _______4______ and is often ________5________ (broken into pieces).

1. distal 2. osteoporosis 3. Colles 4. dorsally 5. comminuted

Anterior dislocation of the lunate is an uncommon but serious injury that usually results from a fall on the _________1__________ wrist. The lunate is pushed out of its place in the floor of the carpal tunnel toward the palmar surface of the wrist. The displaced lunate may compress the ____2______ nerve and lead to carpal tunnel syndrome. Because of its poor blood supply, _____3_____ __________ of the lunate may occur. In some cases, excision of the lunate may be required. In degenerative joint disease of the wrist, surgical fusion of carpals (________4_______) may be necessary to relieve the severe pain.

1. dorsiflexed 2. median 3. avascular necrosis 4. arthrodesis

Injury or disease may damage the musculotendinous rotator cuff, producing instability of the _________1_________ joint. Trauma may tear or rupture one or more of the tendons of the _____2______ muscles. The _______3________ tendon is most commonly ruptured

1. glenohumeral 2. TISS (Teres minor, Infraspinatus, Supraspinatus, Subscapularis) 3. supraspinatus Degenerative tendonitis of the rotator cuff is common, especially in older people

An ________1_________ fracture of the humerus results from a severe fall on the _____2______ elbow. The _______3_______ of the ulna is driven like a wedge between the medial and lateral parts of the condyle of the humerus, separating one or both parts from the humeral shaft.

1. intercondylar 2. flexed 3 olecranon

When the serratus anterior is paralyzed owing to injury to the ___1____ _________ nerve, the medial border of the scapula moves laterally and posteriorly away from the thoracic wall, giving the scapula the appearance of a ____2____, especially when the person leans on a hand or presses the upper limb against a wall.

1. long thoracic 2. wing

Fracture of the hamate may result in non-union of the fractured bony parts because of the traction produced by the attached ____1____. Because the ____2____ nerve is close to the hook of the hamate, the nerve may be injured by this fracture, causing decreased grip ______3_____ of the hand. The ____4_____ artery may also be damaged when the hamate is fractured.

1. muscles 2. ulnar 3. strength 4. ulnar

A positive response of the bicipital reflex confirms the integrity of the ________1_________ nerve and the ____ and _____ spinal cord segments. Excessive, diminished, or prolonged (hung) responses may indicate central or peripheral nervous system disease, or metabolic disorders (e.g., ____3______ disease).

1. musculocutaneous 2. C5 and C6 3. thyroid

Fracture of the _______1_______, called a "fractured elbow" by laypersons, is common because the ________1_______ is subcutaneous and protrusive. The typical mechanism of injury is a fall on the elbow combined with sudden powerful contraction of the _____2____ _________.

1. olecranon 2. triceps brachii The fractured olecranon is pulled away by the active and tonic contraction of the triceps, and the injury is often considered to be an avulsion fracture

Ulnar nerve injury occurs most commonly where the nerve passes ______1______ to the _____2_____ ___________ of the humerus

1. posterior 2. medial epicondyle

Bull rider's thumb refers to a sprain of the ____1____ ___________ ligament, and an avulsion fracture of the _____2______ part of the proximal phalanx of the thumb. This injury is common in individuals who ride mechanical bulls.

1. radial collateral 2. lateral

While potential collateral pathways (periarticular anastomoses) exist around the shoulder joint proximally, and the elbow joint distally, surgical ligation of the axillary artery between the origins of the ______1________ artery and the __________2___________ artery will cut off the blood supply to the arm because the collateral circulation is inadequate.

1. subscapular 2. profunda brachii

Rupture, tearing, or stretching of the ulnar collateral ligament (UCL) are increasingly common injuries related to athletic ______________. Reconstruction of this torn ligament is known as __________ ___________ procedure

1. throwing 2. Tommy John

A ______1_______ fracture of the shaft of the humerus frequently results from a direct blow to the arm. The pull of the _____2_____ muscle carries the proximal fragment laterally

1. transverse 2. deltoid

After ulnar nerve injury, the person has difficulty making a fist because, in the absence of opposition, the metacarpophalangeal joints become hyperextended, and he or she cannot flex the _____ and ______ digits at the distal interphalangeal joints when trying to make a fist.

4th and 5th

Fracture of the _______ metacarpal, often referred to as a boxer's fracture, occurs when an unskilled person punches someone with a closed and abducted fist.

5th

Dupuytren contracture

A disease of the palmar fascia resulting in progressive shortening, thickening, and fibrosis of the palmar fascia and aponeurosis. The fibrous degeneration of the longitudinal bands of the palmar aponeurosis on the medial side of the hand pulls the 4th and 5th fingers into partial flexion at the metacarpophalangeal and proximal interphalangeal joints

What are the instances leading to the anterior dislocation of the glenohumeral joint? What is the clinical presentation?

A hard blow to the humerus when the glenohumeral joint is fully abducted tilts the head of the humerus inferiorly onto the inferior weak part of the joint capsule. This may tear the capsule and dislocate the shoulder so that the humeral head comes to lie inferior to the glenoid cavity and anterior to the infraglenoid tubercle. The strong flexor and adductor muscles of the glenohumeral joint usually subsequently pull the humeral head anterosuperiorly into a subcoracoid position. Unable to use the arm, the person commonly supports it with the other hand.

What is the backpacker's palsy?

A superior brachial plexus injury may produce muscle spasms and severe disability in hikers (back-packer's palsy) who carry heavy backpacks for long periods.

What are the dangers of the injury to the proximal axillary vein?

A wound in the proximal part of the axillary vein is particularly dangerous, not only because of profuse bleeding but also because of the risk of air entering it and producing air emboli (air bubbles) in the blood.

What is an acute brachial plexus neuritis?

Acute brachial plexus neuritis (brachial plexus neuropathy) is a neurologic disorder of unknown cause that is characterized by the sudden onset of severe pain, usually around the shoulder. Typically, the pain begins at night and is followed by muscle weakness and sometimes muscular atrophy (neurologic amyotrophy). Inflammation of the brachial plexus (brachial neuritis) is often preceded by some event (e.g., upper respiratory infection, vaccination, or non-specific trauma). The nerve fibers involved are usually derived from the superior trunk of the brachial plexus.

Which dislocation of glenohumeral joint is more common and which one is less common?

Anterior dislocations are more common that posterior dislocations

What is the clinical presentation of the axillary nerve damage?

Axillary nerve injury is indicated by paralysis of the deltoid (manifest as an inability to abduct the arm to or above the horizontal level) and loss of sensation in a small area of skin covering the central part of the deltoid

What is the consequence of the supraspinatus tendon rupture/tare and lack of function?

Because the supraspinatus muscle is no longer functional with a complete tear of the rotator cuff, the person cannot initiate abduction of the upper limb. If the arm is passively abducted 15° or more, the person can usually maintain or continue the abduction using the deltoid.

Injuries to superior parts of the brachial plexus (____ and ____) usually result from an excessive ______1_______ in the angle between the ____2____ and _______________.

C5 and C6 1. increase 2. neck and shoulder.

What is a Carpal tunnel syndrome and what is it commonly caused by?

Carpal tunnel syndrome results from any lesion that significantly reduces the size of the carpal tunnel or, more commonly, increases the size of some of the nine structures or their coverings that pass through it (e.g., inflammation of synovial sheaths). Fluid retention, infection, and excessive exercise of the fingers may cause swelling of the tendons or their synovial sheaths.

In whom clavicular fractures are common? Causes of clavicular fractures. The weakest part of the clavicle.

Children Causes: often caused by an indirect force transmitted from an outstretched hand through the bones of the forearm and arm to the shoulder during a fall. A fracture may also result from a fall directly on the shoulder. The weakest part of the clavicle is the junction of its middle and lateral thirds.

How can the cords of the brachial plexus be compressed? What are the common neurologic symptoms of brahcial plexus compression?

Compression of cords of the brachial plexus may result from prolonged hyperabduction of the arm during performance of manual tasks over the head, such as painting a ceiling. The cords are impinged or compressed between the coracoid process of the scapula and the pectoralis minor tendon. Common neurologic symptoms are pain radiating down the arm, numbness, paresthesia (tingling), erythema (redness of the skin caused by capillary dilation), and weakness of the hands.

When a compression of the axillary artery become beneficial?

Compression of the third part of this artery against the humerus may be necessary when profuse bleeding occurs (e.g., resulting from a stab or bullet wound in the axilla).

Calcific scapulohumeral bursitis. What is it? Where is it found? What is the presentation?

Deposition of calcium in the supraspinatus tendon is common. This causes increased local pressure that often causes excruciating pain during abduction of the arm; the pain may radiate as far as the hand. The calcium deposit may irritate the overlying subacromial bursa, producing an inflammatory reaction known as subacromial bursitis.

In addition to the atrophy of the deltoid, what else serves as a good sign for axillary nerve injury?

In addition to atrophy of the deltoid, a loss of sensation may occur over the lateral side of the proximal part of the arm, the area supplied by the superior lateral cutaneous nerve of the arm, the cutaneous branch of the axillary nerve.

What muscle(s) are affected by an injury of dorsal scapular nerve? What is the presentation?

Injury to the dorsal scapular nerve, the nerve to the rhomboids, affects the actions of these muscles. If the rhomboids on one side are paralyzed, the scapula on the affected side is located farther from the mid-line than that on the normal side.

What is the characteristic presentation of the superior trunk of brachial plexus injury?

Injury to the superior trunk of the plexus is apparent by the characteristic position of the limb ("waiter's tip position"), in which the limb hangs by the side in medial rotation

What is the Tommy John procedure? And where are the replacement ligament are taken from?

Involves an autologous transplant of a long tendon from the contralateral forearm or leg (e.g., the palmaris longus or plantaris tendon). A 10- to 15-cm length of tendon is passed through holes drilled through the medial epicondyle of the humerus and the lateral aspect of the coronoid process of the ulna.

What is a consequence of the axillary artery aneurysm? Who is more prone to axillary artery aneurysm?

It can compress the trunks of the brachial plexus, causing pain and anesthesia (loss of sensation) in the areas of the skin supplied by the affected nerves. Aneurysm of the axillary artery may occur in baseball pitchers and football quarterbacks because of their rapid and forceful arm movements.

Elbow tendinitis (tennis elbow). What is it caused by? And how is it presented?

It is a painful musculoskeletal condition that may follow repetitive use of the superficial extensor muscles of the forearm. Pain is felt over the lateral epicondyle and radiates down the posterior surface of the forearm. People with elbow tendinitis often feel pain when they open a door or lift a glass. Repeated forceful flexion and extension of the wrist strain the attachment of the common extensor tendon, producing inflammation of the periosteum of the lateral epicondyle (lateral epicondylitis).

Thus the integrity of the deep branch of the radial nerve may be tested by asking the person to extend the _______ joints while the examiner provides resistance

MP

Ankylosis of Sternoclavicular Joint

Movement at the SC joint is critical to movement of the shoulder. When ankylosis (stiffening or fixation) of the joint occurs, or is necessary surgically, a section of the center of the clavicle is removed, creating a pseudojoint or "flail" joint to permit scapular movement.

Inferior dislocation of the glenohumeral joint. When does it often occur?

Often occurs after an avulsion fracture of the greater tubercle of the humerus, owing to the absence of the upward and medial pull produced by muscles attaching to the tubercle.

In _________ syndrome, both the pectoralis major and minor are absent; breast hypoplasia and absence of two to four rib segments are also seen

Poland

When does dislocation of the elbow joint occur and in what direction? What are possible causes? And what are the damaged structures?

Posterior dislocation of the elbow joint may occur when children fall on their hands with their elbows flexed. Dislocations of the elbow may also result from hyperextension or a blow that drives the ulna posterior or posterolateral. The distal end of the humerus is driven through the weak anterior part of the fibrous layer of the joint capsule as the radius and ulna dislocate posteriorly. The ulnar collateral ligament is often torn, and an associated fracture of the head of the radius, coronoid process, or olecranon process of the ulna may occur. Injury to the ulnar nerve may occur, resulting in numbness of the little finger and weakness of flexion and adduction of the wrist.

What is the consequence of the median nerve injury proximal to flexor retinaculum?

Results in paralysis of the thenar muscles and the first two lumbricals. Hence opposition of the thumb is not possible and fine control movements of the 2nd and 3rd digits are impaired. Sensation is also lost over the thumb and adjacent two and a half fingers.

Why in younger people does fracture-dislocation of the proximal humeral epiphysis occur? And what heppens if the fracture is severe?

Severe fracture is on the right Because the joint capsule of the glenohumeral joint, reinforced by the rotator cuff (tendons of the TISS muscles), is stronger than the epiphysial plate. In severe fractures, the shaft of the humerus is markedly displaced, but the humeral head retains its normal relationship with the glenoid cavity of the scapula

When a dislocation of the acromioclavicular joint is considered to be severe? What is the presentation?

Severe when both the AC and coracoclavicular ligaments are torn. When the coracoclavicular ligament tears, the shoulder separates from the clavicle and falls because of the weight of the upper limb. Rupture of the coracoclavicular ligament allows the fibrous layer of the joint capsule to be torn so hat the acromion can pass inferior to the acromial end of the clavicle. Dislocation of the AC joint makes the acromion more prominent, and the clavicle may move superior to this process.

Simian hand

Simian hand refers to a deformity in which thumb movements are limited to flexion and extension of the thumb in the plane of the palm (due to median nerve injury at the wrist). This condition is caused by the inability to oppose and by limited abduction of the thumb. The recurrent branch of the median nerve to the thenar muscles.

What is hemostasis?

Stopping bleeding through manual or surgical control of blood flow

When may axillary nerve be injured?

The axillary nerve may be injured when the gleno-humeral joint dislocates because of its close relation to the inferior part of the joint capsule. The subglenoid displacement of the head of the humerus into the quadrangular space damages the axillary nerve

Where is the best location to compress the brachial artery to control the hemorrhage?

The best place to compress the brachial artery to control hemorrhage is medial to the humerus near the middle of the arm

What is the most likely cause of the radial head dislocation/subluxation?

The child is suddenly lifted (jerked) by the upper limb while the forearm is pronated (e.g., lifting a child)

What is most likely clinical presentation of a child with a dislocated radial head? What is the mechanism what ligament is torn?

The child may cry out, refuse to use the limb, and protect their limb by holding it with the elbow flexed and the forearm pronated The sudden pulling of the upper limb tears the distal attachment of the anular ligament, where it is loosely attached to the neck of the radius. The radial head then moves distally, partially out of the "socket" formed by the anular ligament. The proximal part of the torn ligament may become trapped between the head of the radius and the capitulum of the humerus.

What is adhesive capsulitis? What is it also known as? And it found in what age group most commonly?

("frozen shoulder") Adhesive fibrosis and scarring between the inflamed joint capsule of the glenohumeral joint, rotator cuff, subacromial bursa, and deltoid. Condition seen in individuals 40-60 years of age. A person with this condition has difficulty abducting the arm and can obtain an apparent abduction of up to 45° by elevating and rotating the scapula. Because of the lack of movement of the glenohumeral joint, strain is placed on the AC joint, which may be painful during other movements (e.g., elevation, or shrugging, of the shoulder).

Avulsion (forced separation) of the medial epicondyle in children can result from a fall that causes severe ______1_________ of the extended elbow, an abnormal movement of this articulation. The resulting traction on the ulnar collateral ligament pulls the medial epicondyle ____2_____ .

1. abduction 2. distally

Inflammation of the bicipital tendon (____1______ ___________), usually the result of repetitive microtrauma, is common in sports involving throwing (e.g., ____2______ and __________), and use of a racquet (e.g., _____3______). A tight, narrow, and/or rough intertubercular sulcus may irritate and inflame the tendon, producing tenderness and crepitus (crackling sound)

1. biceps tendinitis 2. baseball and cricket 3. tennis

The superior horizontal border of the __________1___________, the medial border of the ____2____, and the inferolateral border of the _______3_______ form a triangle of auscultation

1. latissimus dorsi 2. scapula 3. trapezius

In approximately 20% of people, a ____1_____ ___________ vein (median vein of the forearm) divides into a _____2____ ________ vein, which joins the basilic vein of the arm. and a _____3______ ____________ vein, that joins the cephalic vein of the arm. It is important to observe and remember that either the median _____4_____ vein or the median _____5_____ vein, whichever pattern is present, crosses superficial to the brachial artery, from which it is separated by the ____________ __________________ .

1. median antebrachial 2. median basilic 3. median cephalic 4. cubital 5. basilic 6. bicipital aponeurosis.

Ulnar nerve injury usually produces numbness and tingling (_______1_______) of the _____2______ part of the ______3____ and the _______4______ one and a half fingers

1. paresthesia 2. medial 3. palm 4. medial

What is affected in the median nerve injury?

Flexion of the proximal interphalangeal joints of the 1st-3rd digits is lost and flexion of the 4th and 5th digits is weakened. Flexion of the distal interphalangeal joints of the 2nd and 3rd digits is also lost. Flexion of the distal interphalangeal joints of the 4th and 5th digits is not affected because the medial part of the FDP, which produces these movements, is supplied by the ulnar nerve. Thus, when the person attempts to make a st, the 2nd and 3rd fingers remain partially extended ("hand of benediction")

In whom, the subluxation and dislocation of radial head is common?

Preschool children, particularly girls, are vulnerable to transient subluxation (incomplete dislocation) of the head of the radius (also called "nursemaid's elbow" and "pulled elbow").

Rupture of the tendon of long head of biceps brachii. Presentation and causation.

Rupture of the tendon usually results from wear and tear of an inflamed tendon as it moves back and forth in the intertubercular sulcus of the humerus. The rupture is commonly dramatic and is associated with a snap or pop. The detached muscle belly forms a ball near the center of the distal part of the anterior aspect of the arm (Popeye deformity). Can occur during power lifting, but most common during prolonged tendinitis that weakens it.

What is most likely mechanism of the Colles fracture?

The fracture results from forced extension of the hand, usually as the result of trying to ease a fall by outstretching the upper limb. This fracture is often referred to as a dinner fork deformity because a posterior angulation occurs in the forearm just proximal to the wrist and the normal anterior curvature of the relaxed hand.

When is the pain most severe in subcutaneous olecranon bursitis?

The pain is most severe during flexion of the forearm because of pressure exerted on the inflamed subtendinous olecranon bursa by the triceps tendon.

A musculocutaneous nerve injury results in paralysis of the __________________, ________________, and __________________. Loss of sensation may occur on the __________ surface of the forearm supplied by the lateral antebrachial cutaneous nerve, the continuation of the musculocutaneous nerve

coracobrachialis, biceps, and brachialis. lateral

Humeral fractures often result in one fragment being driven into the spongy bone of the other fragment (____________ fracture)

impacted

The primary clinical manifestation of spinal accessory nerve palsy is a marked by _____________________________ .

ipsilateral weakness when the shoulders are elevated (shrugged) against resistance.

Laceration of the wrist often causes _________ nerve injury because this nerve is relatively close to the surface. In attempted suicides by wrist slashing, the _________ nerve is commonly injured just proximal to the flexor retinaculum.

median

Injuries to the brachial plexus result in ___________ and __________________

paralysis and anesthesia.

A direct blow or indirect injury of the shoulder of a child or adolescent may produce a fracture-dislocation of the _____________ ____________ ____________ .

proximal humeral epiphysis

The ______________ is the most frequently fractured carpal bone. What is most likely mechanism of injury?

scaphoid It often results from a fall on the palm when the hand is abducted, the fracture occurring across the narrow part of the scaphoid.

A fracture of the distal part of the humerus, near the supra-epicondylar ridges, is called a _________________ __________. What may be a possible consequence of this fracture?

supraepicondylar fracture The distal bone fragment may be dis-placed anteriorly or posteriorly. The actions of the brachialis and triceps tend to pull the distal fragment over the proximal fragment, shortening the limb. Any of the nerves or branches of the brachial vessels related to the humerus may be injured by a displaced bone fragment.

Most injuries of the proximal end of the humerus are fractures of the __________ ________.

surgical neck

When inflammation of the tendon and synovial sheath occurs (___________), the digit swells and movement becomes painful.

tenosynovitis

What is affected in the anterior interosseous nerve injury?

the thenar muscles are unaffected, but paresis (partial paralysis) of the flexor digitorum profundus and flexor pollicis longus occurs. When the person attempts to make the "okay" sign, opposing the tip of the thumb and index finger in a circle, a "pinch" posture of the hand results instead owing to the absence of flexion of the interphalangeal joint of the thumb and distal interphalangeal joint of the index finger (anterior interosseous syndrome)

Injury to the radial nerve superior to the origin of its branches to the triceps brachii results in paralysis of the __________, ___________, ____________, and ____________ muscles of the wrist and fingers. What is the clinical sign of the radial nerve damage?

triceps, brachioradialis, supinator, and extensor The characteristic clinical sign of radial nerve injury is wrist-drop—inability to extend the wrist and the fingers at the meta carpophalangeal joints. Instead, the relaxed wrist assumes a partly flexed position owing to unopposed tonus of flexor muscles and gravity

Traction injury of the _________ nerve is a frequent complication of the abduction type of avulsion of the medial epicondyle of the humerus

ulnar

People who ride long distances on bicycles/bikes with their hands in an extended position against the hand grips put pressure on the hooks of their hamates, which compresses their ________ nerves. This type of nerve compression, which has been called handlebar neuropathy, results in sensory loss on the _______ side of the hand, and weakness of the intrinsic hand muscles.

ulnar medial

The following parts of the humerus are in direct contact with the indicated nerves: • Surgical neck: ________ nerve • Radial groove: _________ nerve • Distal end of humerus: __________ nerve • Medial epicondyle: __________ nerve These nerves may be injured when the associated part of the humerus is fractured.

• Surgical neck: axillary nerve. • Radial groove: radial nerve. • Distal end of humerus: median nerve. • Medial epicondyle: ulnar nerve.

What are the clinical presentation of Klumpke pulsy? And why do they occur?

The short muscles of the hand are affected, and a claw hand results. (unable to make a fist/weak) Horner's syndrome occurs (ptosis and miosis caused by damage to T1 white ramus coomunicantes, and consequent interruption of fibers to the cervical sympathetic trunk).

Dislocation of tendon of long head of biceps brachii, in whom is it more common and what is the presentation during dislocation?

The tendon of the long head of the biceps can be partially or completely dislocated from the intertubercular sulcus in the humerus. This painful condition may occur in young persons during traumatic separation of the proximal epiphysis of the humerus. The injury also occurs in older persons with a history of biceps tendinitis. Usually a sensation of popping or catching is felt during arm rotation.

What is the usual clinical appearance of the upper brachial plexus injury?

The usual clinical appearance is an upper limb with an adducted shoulder, medially rotated arm, and extended elbow. The lateral aspect of the forearm also experiences some loss of sensation.

What are the common causes of the superior parts of the brachial plexus injury?

These injuries can occur in a person who is thrown from a motorcycle or a horse, and lands on the shoulder in a way that widely separates the neck and shoulder.

Trigger finger

Thickening of a fibrous digital sheath on the palmar aspect of the digit produces stenosis of the osseofibrous tunnel, the result of repetitive forceful use of the fingers. If the tendons of the FDS and FDP enlarge proximal to the tunnel, the person is unable to extend the finger. When the finger is extended passively, a snap is audible. Flexion produces another snap as the thickened tendon moves. This condition is called digital tenovaginitis stenosans.

During axillary node dissection, two nerves are at risk of injury. What are they? What are the consequences of these nerves being cut?

Thoracodorsal and long thoracic Cutting the long thoracic nerve results in a winged scapula. If the thoracodorsal nerve to the latissimus dorsi is cut, medial rotation and adduction of the arm are weakened, but deformity does not result.

How to test for degenerative tendonitis of the rotator cuff?

To test for degenerative tendonitis of the rotator cuff, the person is asked to lower the fully abducted limb slowly and smoothly. From approximately 90° abduction, the limb will sudenly drop to the side in an uncontrolled manner if the rotator cuff (especially its supraspinatus part) is diseased and/or torn.

Ulnar Canal syndrome

Ulnar canal syndrome (Guyon tunnel syndrome) is manifest by hypoesthesia in the medial one and a half fingers, and weakness of the intrinsic muscles of the hand. "Clawing" of the 4th and 5th fingers (hyperextension at the metacarpophalangeal joint with flexion at the proximal interphalangeal joint) may occur, but—in contradistinction to proximal ulnar nerve injury—their ability to flex is unaffected, and there is no radial deviation of the hand.

When upper brachial plexus injury can also occur?

Upper brachial plexus injuries can also occur in a neonate when excessive stretching of the neck occurs during delivery. (pulling by the head)

Where does tearing of the fibrocartilaginous glenoid labrum most commonly occur? And what is the clinical presentation?

Usually a tear occurs in the anterosuperior part of the labrum. The typical symptom is pain while throwing, especially during the acceleration phase. A sense of popping or snapping may be felt in the glenohumeral joint during abduction and lateral rotation of the arm.

What is a person with latissimus dorsi paralysis cannot do? And what are some limitations?

With paralysis of the latissimus dorsi, the person is unable to raise the trunk with the upper limbs, as occurs during climbing. Furthermore, the person cannot use an axillary crutch because the shoulder is pushed superiorly by it. These are the primary activities for which active depression of the scapula is required.

An ______________________________________ tubercle of the humerus is seen most commonly in middle-aged and elderly people. A small part of the tubercle is "avulsed" (torn away). What is probable cause of this fracture? Muscles (especially the _________________) that remain attached to the humerus pull the limb into medial rotation

avulsion fracture of the greater The fracture usually results from a fall on the acromion, the point of the shoulder. In younger people, an avulsion fracture of the greater tubercle usually results from a fall on the hand when the arm is abducted. subscapularis

Fracture-separation of the distal radial _______________ is common in children because of frequent falls in which forces are transmitted from the hand to the radius. In a lateral radiograph of a child's wrist, dorsal displacement of the distal radial ______________ is obvious. When the _____________ is placed in its normal position during reduction, the prognosis for normal bone growth is good.

epiphysis

The subcutaneous olecranon bursa is exposed to injury during falls on the elbow and infection from abrasions of the skin covering the olecranon. Repeated excessive pressure and friction, as occurs in wrestling, for example, may cause this bursa to become inflamed, producing a _____________________________________

friction subcutaneous olecranon bursitis (e.g., "student's elbow")

Surgery in the inferior part of the axilla puts the thoracodorsal nerve (C6-C8), supplying the _________________, at risk of injury. When is this nerve also vulnerable?

latissimus dorsi The nerve is also vulnerable to injury during mastectomies when the axillary tail of the breast is removed. The nerve is also vulnerable during surgery on scapular lymph nodes because its terminal part lies anterior to them and the subscapular artery.

Sudden severe tension on a long extensor tendon may avulse part of its attachment to the phalanx. The most common result of the injury is a __________ or ____________ ________. What is this deformity commonly caused by? What is the affected structure? And what is the deficit?

mallet or baseball finger This deformity results from the distal interphalangeal joint suddenly being forced into extreme flexion (hyperflexion) when, for example, a baseball is miscaught or a finger is jammed into the base pad. These actions avulse (tear away) the attachment of the tendon to the base of the distal phalanx. As a result, the person cannot extend the distal interphalangeal joint.

When does Bicipitoradial bursitis (biceps bursitis) results in pain?

When the forearm is pronated because this action compresses the bicipitoradial bursa against the anterior half of the tuberosity of the radius