4 Painful Swollen Limb

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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


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