Upper Limb/Greys Upper limb
A 15-year-old girl was brought to the emergency department with a tear of the tendons in the first dorsal compartment of the wrist from a severe bite by a pit bull dog. The injured tendons in this compartment would include which of the following muscles?
1st compartment think thenar (extensor pollicis brevis, abductor pollicis longus) 2nd compartment extensor carpis radialis longus/brevis, 3rd is extensor digitorum and extensor indicis.
A 22-year-old man is admitted to the hospital after a car collision. Radiographic examination reveals an oblique fracture of his humerus. Upon physical examination the patient is unable to extend his forearm. The damaged nerve was most likely composed of fibers from which of the following spinal levels?
5 rats!!! C5-T1
The mastectomy procedure on a 52-year-old woman involved excision of the tumor and removal of lymph nodes, including the pectoral, central axillary, and infraclavicular groups. Six months after her mastectomy, the patient complains to her personal physician of an unsightly deep hollow area inferior to the medial half of the clavicle, indicating a significant area of muscle atrophy and loss. She states that the disfigurement has taken place quite gradually since her mastectomy. Physical examination reveals no obvious motor or sensory deficits. What was the most likely cause of the patient's cosmetic problem?
A branch of the lateral pectoral nerve was cut WOW!
A 23-year-old woman arrives at the emergency department with a swollen, painful forearm. An MRI examination reveals a compartment syndrome originating at the interosseous membrane between the radius and ulna. Which of the following type of joint will most likely be affected? Choices Synarthrosis Symphysis Synchondrosis Trochoid Ginglymus
A synarthrosis joint is a fibrous connection that allows minimal to no movement. In this case, virtually no movement is allowed by the interosseous membrane joint between the radius and ulna.
An 18-year-old man presents to the emergency department with a painful right shoulder after a fall while diving for a soccer ball. A radiograph of the shoulder is shown in Figure 6-12. Examination revealed pain on passive adduction of the right arm across the chest. Which ligamentous structures must have been stretched/torn resulting in this injury? Choices Acromioclavicular joint capsule and coracoclavicular ligament Acromioclavicular joint capsule and coracoacromial ligament Sternoclavicular joint capsule and coracoacromial ligament Coracoclavicular ligament and transverse scapular ligament Coracoclavicular ligament and coracoacromial ligament
Acromioclavicular joint capsule and coracoclavicular ligament
Very hard 3 rd order but take ur time and map out every word of the question! A 30-year-old intoxicated man stumbled while descending stairs and fell on his outstretched and hyperextended hand. Since the fall (2 to 3 hours ago) he has had constant pain in his wrist, but over the past 30 minutes he has developed tingling and burning pain in his hand as well. Radiographs reveal fractures of both the radial and ulnar styloid processes, as well as dislocation of a carpal bone. Which of the following abnormal sensory and motor findings are most likely to be found on examination? Dysesthesia (tingling in response to light touch) along the medial border of the hand and little finger and weakness in adduction of the thumb Dysesthesia over the palm and palmar aspect of the thumb, index, and middle fingers and weakness in thumb opposition Numbness along the medial border of the hand and little finger and weakness in wrist extension Numbness over the dorsum of the hand laterally including the dorsal aspect of the thumb, index, and middle fingers and weakness in grip strength Numbness over the palm and palmar aspect of the thumb, index and middle fingers and weakness in adduction of the thumb
B, lunate is dislocated thus MEDIAN nerve is affected (wow!) causing tingly feeling over the palm and plarmar aspect of the thumb, index, and middle fingers and weakness in thumb opposition.
Laboratory studies in the outpatient clinic on a 24-year-old woman included assessment of circulating blood chemistry. Which of the following arteries is most likely at risk during venipuncture at the cubital fossa?
Brachial! Cubital fossa
acromioclavicular ligament tear is indiciative of ? shoulder separation?
COMPLETE
A 25-year-old woman experiences numbness and tingling in her right arm and hand while carrying a piece of luggage. Physical examination showed no motor or sensory deficits in the upper limb. When asked to abduct her upper limb to 90 degrees and to maintain this position while repeatedly closing and opening her hands, the symptoms are reproduced along the medial border of the limb, from the axilla to the hand. Which nerve structure(s) is/are most likely compressed? Choices Ulnar nerve at the medial epicondyle Radial nerve at the neck of the radius Median nerve in the carpal tunnel Inferior trunk of the brachial plexus Divisions of the brachial plexus
In thoracic outlet syndrome—sometimes caused by a cervical rib or a cervical band—ventral rami or trunks of the brachial plexus can be compressed by these structures as they travel from the neck to the axilla. In this case the inferior trunk of the brachial plexus is being compressed by a cervical rib. The anterior division of the inferior trunk continues as the medial cord of the brachial plexus. The medial brachial cutaneous nerve (medial cutaneous nerve of the arm) and medial antebrachial cutaneous nerve (medial cutaneous nerve of the forearm) are branches of the medial cord of the plexus, with the ulnar nerve as its terminal branch. Additionally, there is medial cord contribution to the median nerve. Compression of the inferior cord of the brachial plexus therefore presents with numbness and paraesthesia on the medial part of the arm, forearm, and hand. GAS 150; N 415; McM 140
A 44-year-old woman is diagnosed with radial nerve palsy. When muscle function is examined at the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints, what findings are most likely to be present?
Inability to extend the MCP joints only, The tendons of the extensor digitorum and extensor digiti minimi muscles, innervated by the radial nerve, are responsible for extension of the MCP and, to a much lesser degree, the proximal (PIP) and distal (DIP) interphalangeal joints. Abduction and adduction of the MCP joints are functions of the interossei, all of which are innervated by the deep ulnar nerve. Extension of the PIP and DIP joints is performed by the lumbricals and interossei. The first two lumbricals are supplied by the median nerve; the other lumbricals and the interossei, by the deep branch of the ulnar nerve.
While using a wood-carving gouge, a 34-year-old woman lacerates the proximal aspect of her palm from the base of the thumb across to the pisiform bone. Neurological examination reveals pronounced weakness in opposition of the thumb, with intact sensation in the hand. Which of the following injuries best accounts for her findings? Choices Injury of the median nerve in the carpal tunnel Injury of the superficial palmar branch of the median nerve Injury of the recurrent and superficial branch of the median nerve Injury of the recurrent median nerve at the wrist Injury of the radial and ulnar nerves
Injury of the recurrent median nerve at the wrist
A 69-year-old woman visits the outpatient clinic with a complaint of numbness and tingling of her hand for the past 3 months. Physical examination reveals she has numbness and pain in the lateral three digits of her right hand that are relieved by vigorous shaking of the wrist. In addition, the abductor pollicis brevis, opponens pollicis, and the first two lumbrical muscles are weakened. Sensation was decreased over the lateral palm and the volar aspect of the first three digits. Which of the following nerves is most likely compressed?
Median, lateral 3 digits dude!!!!
A 34-year-old female skier was taken by ambulance to the hospital after she struck a tree on the ski slope. Imaging gives evidence of a shoulder separation. Which of the following typically occurs in this kind of injury?
Partial or complete tearing of the coracoclavicular ligament
A 52-year-old man is admitted to the emergency department after falling on wet pavement. Radiographic examination reveals fracture of the radius. An MRI study reveals a hematoma between the fractured radius and supinator muscle. Upon physical examination the patient has weakened abduction of the thumb and extension of the metacarpophalangeal joints of the fingers. Which of the following nerves is most likely affected? Anterior interosseous Posterior interosseous Radial nerve Deep branch of ulnar nerve Median nerve
Posterior interosseus, supernator is radial dude!
A 55-year-old male metallurgist had been diagnosed with carpal tunnel syndrome. To begin the operation, an anesthetic injection into his axillary sheath was given instead of general anesthesia. From which of the following structures does the axillary sheath take origin?
Prevertebral fascia (no clue lol)
A 45-year-old man is admitted to the hospital after accidentally walking through a plate glass door in a bar while intoxicated. Physical examination shows multiple lacerations to the upper limb, with inability to flex the distal interphalangeal joints of the fourth and fifth digits. Which of the following muscles is most likely affected?
Profundus: The flexor digitorum profundus muscle is dually innervated by the ulnar nerve to the medial two fingers and the median nerve for the long and index fingers. Because of the superficial course of the ulnar nerve, it is vulnerable to laceration. Such an injury would result in an inability to flex the distal interphalangeal joints of the fourth and fifth digits because the flexor digitorum profundus muscle is the only muscle that flexes this joint. The flexor digitorum superficialis muscle is innervated by the median nerve only, and the course of this nerve runs too deep to be usually affected by lacerations. The lumbricals function to flex the MP joints and assist in extending the IP joints. The interossei adduct and abduct the fingers.
What is Pronator syndrome ?
Pronator syndrome is due to damage of the median nerve as it passes between the two heads of a hypertrophied pronator teres muscle.
A 32-year-old man is admitted to the emergency department after a severe car crash. Radiographic examination reveals multiple fractures of his right upper limb. A surgical procedure is performed and metallic plates are attached to various bony fragments to restore the anatomy. Five months postoperatively the patient visits the outpatient clinic. Upon physical examination the patient can abduct his arm and extend the forearm, and the sensation of the forearm and hand is intact; however, hand grasp is very weak, and he cannot extend his wrist against gravity. Which of the following nerves was most likely injured during the surgical procedure? Choices Posterior cord of the brachial plexus Radial nerve at the distal third of the humerus Radial and ulnar Radial, ulnar, and median Radial and musculocutaneous
Radial nerve at the distal third of the humerus, ulnar nerve is not affected due to ability to adduct wrist. Cannot extend wrist so we know its radial. Sensation is intact so median isnt affected.
A 55-year-old female choreographer had been treated in the emergency department after she fell from the stage into the orchestra pit. Radiographs revealed fracture of the styloid process of the ulna. Disruption of the triangular fibrocartilage complex is suspected. With which of the following bones does the ulna normally articulate at the wrist?
Radius only! distal radioulnar joint
Tenovaginitis stenosans (trigger finger), what is it?
Tenovaginitis stenosans occurs after swelling or nodular growth of the flexor tendon, which interferes with it gliding through the pulley and producing a snap or click on active extension or flexion
A 54-year-old woman was found unconscious on the floor, apparently after a fall. She was admitted to the hospital, and during physical examination it was observed that she had unilateral absence of her brachioradialis reflex. Which spinal nerve is primarily responsible for this reflex in the majority of cases?
The C6 spinal nerve is primarily responsible for the brachioradialis reflex. C5 and C6 are both involved in the biceps brachii reflex; C5 for motor, C6 for the sensory part of the reflex arc; C7 is the key spinal nerve in the triceps reflex.
A 55-year-old right-handed woman presents to the clinic with a 1-week history of right elbow pain. The pain started after a long game of competitive tennis. The pain begins in the elbow and at times radiates into the forearm. Splinting of the elbow decreases the intensity of the pain. During physical examination of the elbow mild swelling and tenderness are noted over the lateral epicondyle. Which one of the following wrist movements, if carried out by the patient with a closed fist and against resistance, will most likely exacerbate the pain? choices Radial deviation Ulnar deviation Flexion Extension Flexion and ulnar deviation
The lateral epicondyle is the common extensor origin. Most of the extensor muscles of the forearm originate from this area. Putting those muscles in action will exacerbate pain on the lateral epicondyle, a condition nicknamed "tennis elbow." Radial and lateral deviations have no effect because the movement is at the wrist joint. Flexion exacerbates pain on the medial epicondyle if the patient has "golfer's elbow." GAS 752, 785, 768; N 427; McM 145
A 28-year-old telephone company worker falls off a street pole during a telephone line repair and lands directly on his right shoulder. Plain radiographs reveal a vertical fracture through the entire length of the floor of the intertubercular sulcus of the right humerus. The muscle that is most likely affected by the fracture is innervated by a nerve that is composed of which of the following nerve roots? Choices C3 and C4 C6 to C8 C4 and C5 C2 to C4 C5 to C7
The muscle that attaches into the intertubercular sulcus of the humerus is the latissimus dorsi. Nerve supply is via the thoracodorsal nerve, which is a branch of the posterior cord and is made up of roots C6-8. Nerves C2, C3 and C4 are not part of the brachial plexus but of the cervical plexus and will supply the "strap" muscles. Nerves C4 and C5 are the main contributions to the phrenic nerve, and C5 does not contribute to the formation of the thoracodorsal nerve. GAS 728; N 416; McM 115
An emergency department physician evaluates a 28-year-old man who injured his hand in a knife fight. The physician notes that the ring and little fingers cannot be extended at the interphalangeal joints, and the patient cannot spread the fingers of his injured hand. Weakness of which of the following muscles is the major reason for the loss of interphalangeal extension of the medial two fingers? Choices Dorsal interosseus muscles Extensor digitorum Lumbrical muscles Palmar interosseus muscles Extensor digiti minimi
The patient likely has damage to the ulnar nerve, which affected both the interossei and medial two lumbricals. The lumbricals extend the interphalangeal joints of the ring and little fingers, while the interossei are responsible for abduction and adduction of the digits. The dorsal interossei are responsible for abduction, while the palmar interossei are responsible for adduction of the digits. The extensor digit minimi is responsible for extension of the little finger only and if damaged will not affect the ring finger. If the extensor digitorum were damaged it would lead to weakness of all four digits, not only the ring and little fingers. GAS 814; N 488; McM 159
A 23-year-old male medical student fell asleep in his chair with Netter's Atlas wedged into his axilla. When he awoke in the morning, he was unable to extend his wrist or fingers. Movements of the ipsilateral shoulder joint appear to be normal. Which of the following nerves was most likely compressed, producing the symptoms described?
The radial nerve is the most likely nerve compressed to cause these symptoms. This type of nerve palsy is often called "Saturday night palsy." One reason for this nickname is that people would supposedly fall asleep after being intoxicated on a Saturday night with their arm over the back of a chair or bench, thereby compressing the nerve in the spiral groove. The radial nerve innervates all of the extensors of the elbow, wrist, and fingers.
A 27-year-old man had lost much of the soft tissue on the dorsum of his left hand in a motorcycle crash. Imaging studies show no other upper limb injuries. Because function of the left extensor carpi radialis longus and brevis tendons was lost, it was decided to replace those tendons with the palmaris longus tendons from both forearms because of their convenient location and relative unimportance. Postoperatively, it is found that sensation is absent in both hands on the lateral palm and palmar surfaces of the first three digits; there is also paralysis of thumb opposition. What is the most likely cause of the sensory deficit and motor loss in both thumbs?
The surgeon took the distal segments of the median nerves from both forearms, mistakenly believing them to be palmaris longus tendons. Both of the structures lie in the midline of the ventral surface of the distal forearm and are often of similar appearance in color and diameter. The nerve is located deep to the tendon, when the tendon is present, but when the tendon is absent, the nerve appears to be where the tendon belongs. There is no evidence of rib fractures; even so, a fractured rib would not explain loss of sensation on the lateral portion of the palm. Lower plexus trauma (C8, T1) would result in paralysis of forearm flexor muscles and all intrinsic hand muscles and sensory loss over the medial dorsum of the hand, in addition to palmar sensory loss. Dupuytren's contracture is a flexion contracture of (usually) digits four and five from connective tissue disease in the palm. Radial nerve injury in the posterior forearm would affect metacarpophalangeal joint extension, thumb extension, and so on, not palmar disturbances.
A 62-year-old man visits the outpatient clinic with pain after falling on his outstretched hand. Radiographic examination reveals a fracture of the pisiform bone and hematoma of the surrounding area. Which of the following nerves will most likely be affected? Choices Ulnar Radial Median Deep ulnar Deep radial
The ulnar nerve enters the forearm by passing between the two heads of the flexor carpi ulnaris and descends between and innervates the flexor carpi ulnaris and flexor digitorum profundus (medial half) muscles. It enters the hand superficial to the flexor retinaculum and lateral to the pisiform bone, where it is vulnerable to damage and provides the deep ulnar branch. The deep branch of the radial nerve arises proximally in the forearm.
the second u hear digits 4/5 flexed and 2/3 are extended think?
benedicts hand! Median nerve injury at the supracondyle
A 5-year-old boy is admitted to the emergency department after falling from a tree. The parents are informed by the radiologist that their son's fracture is the most common fracture that occurs in children. Which of the following bones was broken?
clavicle!
A 35-year-old man has a small but painful tumor under the nail of his little finger. Which of the following nerves would have to be anesthetized for a painless removal of the tumor?
common palmar digital of ulnar! superficial branch of the ulnar nerve and supplies skin of the little and medial side of the ring finger.
paleness and loss of pulses distal to the compartment is a major sign of?
compartment syndrome
A 47-year-old female tennis professional is informed by her physician that she has a rotator cuff injury that will require surgery. Her physician explains that over the years of play, a shoulder ligament has gradually caused severe damage to the underlying muscle. To which of the following ligaments is the physician most likely referring?
coracoacromial ligament! Strong ligament, preventing superior displacement of the head of the humerus.
A 22-year-old male construction worker is admitted to the hospital after he suffers a penetrating injury to his upper limb from a nail gun. Upon physical examination, the patient is unable to flex the distal interphalangeal joints of digits 4 and 5. What is the most likely cause of his injury?
digitorum profundus! Why? the Ulnar near was penetrated and we know the flexor digitorum profundus is half innervated by the ulnar near medially!!!!!
Examination of a 21-year-old female athlete with an injury of the radial nerve in the spiral groove would typically demonstrate which of the following physical signs?
dont just think superficial extensor muscles, think deep! abductor pollicis longus!!!
A 22-year-old male medical student was seen in the emergency department with a complaint of pain in his right hand. He confessed that he had hit a vending machine in the hospital when he did not receive his soft drink after inserting money twice. The medial side of the dorsum of the hand was quite swollen, and one of his knuckles could not be seen when he "made a fist." The physician made a diagnosis of a "boxer's fracture." What was the nature of the impatient student's injury?
fracture of the fifth metacarpal of boxer's fracture!!!
injury to the ulnar collateral ligament of the thumb is called what?
gamekeeper's
A 25-year-old woman fashion model has an unsightly lump on her wrist that is causing her great distress. She also reports a tingling sensation on the lateral three and a half digits of the palmar aspect of her hand. Her doctor uses his pen torch to illuminate the lump and then uses a syringe to drain its contents. What is the most likely diagnosis of this condition? Choices Neurofibroma Ganglion cyst Chondroma Osteoma Osteophyte
ganglion cyst, has fluid in it!! occurs in hands and feet
A 29-year-old patient has a dislocated elbow in which the ulna and medial part of the distal humerus have become separated. What classification of joint is normally formed between these two bones? Choices Trochoid Ginglymus Enarthrodial Synarthrosis Sellar
ginglymus
It was reported by the sports media that the outstanding 27-year-old shortstop for a New York team would miss a number of baseball games. He was hit on a fingertip while attempting to catch a ball bare-handed. A tendon had been torn. The team doctor commented that the ballplayer could not straighten the last joint of the long finger of his right hand, and the finger would require surgery. From what injury did the ballplayer suffer?
mallet finger!
TOTAL clawing of the hand results from?
median nerve (thenar) and ulnar nerve damaged at wrist
the second u hear oschner test, think?
median nerve cubital fossa!
A 32-year-old woman is admitted to the emergency department after an automobile collision. Radiologic examination reveals multiple fractures of the humerus. Flexion and supination of the forearm are severely weakened. She also has loss of sensation on the lateral surface of the forearm. Which of the following nerves has most likely been injured?
musculotaneous! Musculotaneous continues as lateral antebrachial cutaneous nerve, supplies sensation so the lateral side of the forearm.
A 49-year-old woman who had suffered a myocardial infarction must undergo a bypass graft procedure using the internal thoracic artery. Which vessels will most likely continue to supply blood to the anterior part of the upper intercostal spaces?
posterior intercostal artery: The upper artery lying in each space anastomoses with the posterior intercostal arteries, whereas the lower one usually joins the collateral branch of the posterior intercostal artery.
midshaft fracture affects nn and a?
radial nerve and deep brachial artery
The ? nerve directly passes through the supinator muscle?
radial nerve!
After a forceps delivery of an infant boy, the baby presents with his left upper limb adducted, internally rotated, and flexed at the wrist. The startle reflex is not seen on the ipsilateral side. Which part of the brachial plexus was most likely injured during this difficult delivery? What rami/trunk is affect?
so we know it's erbs duchenne palsy (c5, c6 , c7) but the part of the brachial plexus affected is the ventral rami of the upper trunk (c5, c6).
A 29-year-old woman is examined in the emergency department after falling from her balcony. Radiographic examination reveals that she has suffered a broken clavicle, with associated internal bleeding. Which of the following vessels is most likely to be injured in clavicular fractures?
subclavian vein!
A 41-year-old woman is admitted to the hospital after a car crash. Radiographic examination reveals a transverse fracture of the radius proximal to the attachment of the pronator teres muscle. The proximal portion of the radius is deviated laterally. Which of the following muscles will most likely be responsible for this deviation?
supinator
Following several days of 12-hour daily rehearsals of the symphony orchestra for a performance of a Wagnerian opera, the 52-year-old male conductor experienced such excruciating pain in the posterior aspect of his right forearm that he could no longer direct the musicians. When the maestro's forearm was palpated 2 cm distal and posteromedial to the lateral epicondyle, the resulting excruciating pain caused him to grimace. Injections of steroids and rest were recommended to ease the pain. Which of the following injuries is most likely? Is it compression of the superficialradial nerve of the brachioradialis or the deep radial nerve of the supinator?
supinator deep radial! see pic
volkmanns fracture affects what?
supracondylar line of humerus, #93
what ligament becomes stretch when breasts sag considerably?
suspensory cooper's ligaments
A 67-year-old housepainter visits the outpatient clinic complaining that his hands are getting progressively worse, becoming more and more painful and losing their function. On physical examination of the hands, there is flexion of the metacarpophalangeal joints, extension of the proximal interphalangeal joints, and slight flexion of the distal interphalangeal joints. What is the most likely diagnosis?
swan neck
paraesthesia along the medial surface of the forearm and palm and weakness and atrophy of gripping muscles ("long flexors") and the intrinsic muscles of the hand. What is this indicative of?
thoracic outlet syndrome
what important artery accompnies the ulnar nerve?
ulnar collateral artery, it anasatmoses with the inferior ulnar collateral artery anterior to the elbow. Notice how its near medial epicondyle