4 Painful Swollen Limb
Functions of thigh compartments
A - hip flexion, extend knee P - hip extension M - hip adduction
What mm. are in anterior arm compartment + IN
biceps brachii, brachialis, coracobrachialis - musculocutaneous n.
Muscles in posterior thigh + IN
biceps femoris, semimembranosus, semitendinosus - sciatic n.
Scapular fracture - MOI, watch for
blunt trauma (survey) - watch for floating shoulder (big vasculature around)
Superficial muscles of posterior forearm - radial to ulnar
brachioradialis, extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor digitorum, extensor digiti minimi (EDM), extensor carpi ulnaris (ECU)
Femoral nerve becomes femoral after passing ______
deep to inguinal ligament
Mid shaft humerus fracture - MOI, what structure MUST you assess
direct, forceful blow (MVA) - radial nerve
PE for acute fx - most important
distal pulses
Most common fx in adults, kids, and adolescents
distal radius
IN of rhomboids and levator scapulae
dorsal scapular n.
Anterior compartment of leg functions + IN
dorsiflexion, inversion, toe extension - deep fibular n.
Empty can test - what muscle?
downward pressure to distal humerus - test supraspinatus
Lateral leg functions + vascular
eversion, plantar flexion - fibular a./v.
Posterior thigh vascular/lymph + function
extend hip, flex knee - profunda femoris a./v. - deep inguinal nodes
Posterior forearm function? IN? vascular?
extension, supination - radial n. - radial a./v.
Radial head fracture - MOI, types
fall on abducted arm
Anterior thigh vascular + lymph
femoral a./v. deep inguinal nodes
Lateral compartment of leg muscles + IN
fibularis longus + brevis - superficial fibular n.
Anterior forearm function? IN? vascular?
flexion, pronation - median n. - ulnar a./v.
What superficial muscle in anterior forearm has different IN?
flexor carpi ulnaris (FCU) = ulnar n. rather than typical median n. of rest of compartment
Deep layer muscles of anterior forearm
flexor digitorum profundus (FDP), flexor pollicis longus (FPL - radial side), pronator quadratus (deep to FDP and FPL)
Intermediate layer muscle of anterior forearm
flexor digitorum superficialis (FDS)
Posterior leg compartment superficial muscles + IN
gastrocnemius, soleus, plantaris - tibial n.
Cartilaginous surface that deepens glenoid fossa
labrum inside joint capsule
Common fibular n. IN what leg compartment Deep fibular?
lateral - anterior, runs w/anterior tibial a.
Musculocutaneous n. - off _____ cord, IN (3)
lateral - coracobrachialis, biceps brachii, brachialis
Median n. off ____ and ___ cords (M shape)
lateral and medial
Branch of musculocutaneous n. is ____ of forearm and does ______ sensation of forearm
lateral cutaneous, lateral aspect
Serratus anterior IN
long thoracic nerve
Fx displacement
malalignment of proximal and distal fx fragments e.g. dorsal away from palm
H&P for fx
mechanism for injury, steroid use - examine joints above and below - neurovasculature, gross sensation
Ulnar n. off _____ cord
medial
What separates compartments of arm
medial and lateral intermuscular septum
Where is coracobrachialis
medial part of the upper arm - deep to biceps
Phalen's test
median n. impinegement (carpal tunnel) - hold for 1 min + if numb/tingle
Tinel test
median nerve impingement (carpal tunnel) - tap on median nerve + if pain/tingle
Functions of upper limb
mobility, positioning of hand
Complications of scaphoid fx
non union and osteonecrosis
Medial thigh vascular/lymph
obturator a./v. deep inguinal nodes
Pes anserine
sartorius, gracilis, semitendinosus (SGT) - tendonous meeting at tibia
Carpal fx - most common bone, MOI, sx
scaphoid, FOOSH, anatomic snuff box tenderness
Function of triceps? IN?
shoulder/elbow extension - radial n.
Function of anterior arm compartment? Vascular?
shoulder/elbow flexion - brachial a./v.
Where does appendicular skeleton articulate with axial skeleton
shoulder/pectoral girdle + pelvic girdle
Transverse fx Oblique Comminuted
straight line across diagonal (nutrition, cancer) tiny pieces
Sprain
stretch/tear of ligament - grade 1 (mild) 2 (partial tear) 3 (complete)
Deep muscles of posterior forearm
supinator, extensor indicis
Most common upper arm injury in kids
supracondylar
Forearm lymph?
supratrochlear nodes
Anterior compartment of leg muscles
tibialis anterior, extensor hallucis longus, extensor digitorum longus, fibularis tertius
Popliteal fossa - what's in it
tibila n., popliteal v. then artery (deepest)
Posterior compartment of arm - muscle?
triceps brachii - long head b/t teres minor/major, lateral and medial head
Clavicle fracture - common in _____
vaginal deliveries - adults need more force
Functions of lower limb
weight bearing, movement, stability
Proximal humerus fracture - common in who/what situation
>65yo, women, ground level fall, FOOSH
W/u of suspected bone fx
2 view radiograph
Remind strength scale
5/5 against gravity, full resistance 4/5 against gravity, some resistance - weak 3 - against gravity only 2 - passive only, not against gravity 1 - trace movement 0 - no movement
Boxer's fx - most likely finger, MOI
5th MC, direct blow to area with clenched fist
IN of trapezius? latissimus dorsi?
CN XI - thoracodorsal
Diarthrosis vs synarthrosis vs amphiarthrosis
Di - freely moving (hip) Syn - no movement (sutures) Amphi - slightly moveable (pubic symphysis)
Supracondylar fracture - MOI, pathognomonic xray sign
FOOSH - broken hourglass
Salter Harris classification
I: Physis only (w/in growth plate) II: Physis + metaphysis (above) III: Physis + epiphysis (below) IV: Metaphysis, physis, + epiphysis (both) V: Crushed physis
Name parts of brachial plexus
Roots (C5-T1), trunks, divisions, cords, branches
How to tell strain vs sprain
Sprain should NOT have joint laxity Strain can have joint laxity
Muscles in anterior thigh
Vastus lateralis, rectus femoris, vastus medialis, sartorius
Obturator n. passes b/t _____
adductor brevis and longus
Medial thigh muscles + IN
adductor longus, adductor brevis, adductor magnus, gracilis - obturator n.
Adductor magnus has 2 parts (IN, function)
adductor part (obturator n.) - adducts hips hamstring part (sciatic n.) - extends hip
Compartments of thigh + what IN
anterior (femoral), posterior (sciatic), medial (obturator)
Anterior compartment leg vascular
anterior tibial a./v.
Compartments of the leg
anterior, lateral, posterior (superficial and deep)
Terminal branches of brachial plexus + what they IN
axillary (deltoid, teres minor), radial (post to humerus - off post cord) - off anterior cord - musculocutaneous (coracobrachialis), median (midline to forearm), ulnar (forearm, hand)
Test subscapularis vs infraspinatus
can't internally rotation - worry subscapularis external for infraspinatus
Simple fx vs Compound
closed fx - bones contained - open fx - bone through skin
Types of distal radius fx + MOI
colles - FOOSH smith - palmar angulation
Sciatic n. splits into
common fibular (medial) and tibial n. - short head - fibular; long - tibial division
Lateral thigh - ____ and ____ insert into ____
gluteus maximus and tensor fassciae latae insert into IT band
Bone repair of fractures (4 steps)
hematoma formation - fibrocartilaginous callous (angiogenesis) - bony callus formation - remodeling
Anterior and posterior arm both drain lymph to
infraclavicular nodes
Fascia lata is extension of
inguinal ligament
Borders of femoral triangle
inguinal ligament, adductor longus, sartorius
Strain - what, when
injury to muscle/tendon - typically during eccentric
Greenstick fx - pediatric
one side bone fx, other side bent
Antagonist muscles do what
oppose action of other muscles
Fx clinical presentation
pain, swelling, DEC ROM, worse w/movement - may be insidious
Posterior superficial compartment of leg functions
plantar flexion and knee flexion
Posterior deep leg functions
plantar flexion, toe flexion, knee flexion, inversion
All leg lymph is
popliteal nodes
Posterior leg deep muscles
popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
Tibial n. IN what leg compartment
posterior
Where are deltoid heads
posterior head on spine of scapula, middle off acromion, anterior off clavicle
Posterior leg vascular
posterior tibial a./v.
Axillary n. off _____ cord, IN (2)
posterior, deltoid and teres minor
Radial n. off _____ cord, IN (1)
posterior, triceps brachii
Posterior arm compartment vascular?
profunda brachii a./v.
Superficial muscles of anterior forearm - radial to ulnar
pronator teres, flexor carpi radialis (FCR), palmaris longus, flexor carpi ulnaris (FCU)
What fractures do you see sail sign (fat pad sign)
radial head and supracondylar (elbow)
Vastus intermedius is deep to __
rectus femoris
Scapulothoracic joint movements - adduction called _____, abduction called
retraction - protraction
Neer's test
rotator cuff impingement - shoulder internally rotated, passively flex arm + with pain