Anatomy (Upper Limb)

Question 1

Sternoclavicular Joint Characteristics (3)

Answer 1

• Only bony articulation of upper limb with trunk
• Limits clavical rotation, elevation, depression, protraction, and retraction
• Strong, which causes clavicle fracture instead of dislocation

Question 2

Clavicle Fracture (4)

Answer 2

• Caused by stong sternoclavicular joint
• Occurs in midshaft
• Medial portion is elevated by sternocleidomastoid and lateral portion is depressed by shoulder weight
• Fall on outstreched hand

Question 3

Acromioclavicular Joint Characteristics (3)

Answer 3

• Stablilizes movement during superior and inferior rotation of scapula
• Weaker than SC joint
• High likelyhood for dislocation

Question 4

Dislocation of Acromioclavicular Joint (3)

Answer 4

• Fall on adducted arm
• Acromion goes inferior and medial
• “Shoulder seperation” when QB gets tackled

Question 5

Glenohumeral Joint Characteristics

Answer 5

• Most movable and very unstable
• Most dislocated joint by far

Question 6

Glenohumeral Joint Dislocatoin

Answer 6

• Most are inferior (then anterior or posterior) due to no rotator cuff muscles at axillary recess

Question 7

Elbow Joint Characteristics (1)

Answer 7

• Flexion and extension of elbow

Question 8

Radioulnar Joint Characteristics (3)

Answer 8

• Pronation and Supination of forearm
• Communicates with elbow joint
• Subluxation of head of radius occurs in children (Nursemaid’s Elbow)

Question 9

Nursemaid’s Elbow (3)

Answer 9

• Extended & Pronated arm is jerked upwards
• Supinating forearm with a flexed elbow treats it
• Occurs in kids

Question 10

Colles Fracture (4)

Answer 10

• Occurs in Radio-Carpal (wrist) joint
• Complete fracture of distal radius with dorsal displacement
• “Dinner fork deformity”
• Catch yourself falling

Question 11

Upper Limb Characteristics & Functions (3)

Answer 11

• Shoulder, arm, forearm, and hand
• Characterized by mobility and ability to graps & manipulatye
• Common place for pain, fractures, dislocations, and nerve injuries

Question 12

Long Thoracic Nerve Lesion

Answer 12

• Stab wound to lateral chest
• Paralysis of serratus anterior
• “Winged Scapula”

Question 13

Suprascapular Nerve Lesion

Answer 13

• Trauma of nerve
• Supraspinatus & infraspinatus muscles

Question 14

Axillary Nerve Lesion

Answer 14

• Fracture of the surgical neck of the humerus
• Deltoid and Teres minor
• Loss of skin sensation

Question 15

Musculocutaneous Nerve Lesion

Answer 15

• Knife wound (hard due to protection from biceps)
• Flexor compartment of arm
• Lateral antebrachial cutaneous nerve

Question 16

Radial Nerve Lesion at Axilla

Answer 16

• “Saturday night palsy”
• Using crutches
• Loss of extension at the elbow, wrist and digits
• Supinator muscle
• Distal sign is “wrist drop.”
• Sensory loss on posterior arm, forearm, and dorsum of thumb

Question 17

Radial Nerve Lesion at Arm

Answer 17

• Mid-shaft fracture of humerus at radial groove
• Lateral elbow (lateral epicondyle fracture or radial head dislocation)
• Loss of forearm extensors of the wrist and digits
• Weakened supination
• Distal sign is “wrist drop.”
• Elbow extension is spared.
• Sensory loss on the posterior forearm and dorsum of thumb

Question 18

Radial Nerve Lesion at Wrist

Answer 18

• Laceration
• No motor loss
• Sensory loss only on dorsal aspect of thumb

Question 19

Median Nerve Lesion at Elbow

Answer 19

• Supracondylar fracture of humerus
• Weakened wrist flexion
• Loss of pronation
• Loss of 2 lateral lumbricals
• Thenar atrophy (flattening of thenar eminence) with loss of thumb opposition (opponens pollicis muscle) results in “ape hand”
• Loss of flexion of lateral 3 digits resulting in the inability to make a complete fist - referred to as the “hand of benediction”
• Sensory loss on palmar surface of the lateral hand and the palmar surfaces of the lateral 3 digits

Question 20

Median Nerve Lesion at Wrist

Answer 20

• Carpal tunnel syndrome or laceration
• Loss of lateral 2 lumbricals
• Thenar atrophy (flattening of thenar eminence)
• Loss of thumb opposition (opponens pollicis muscle)
• “Ape hand”
• Sensory loss on the palmar surfaces of lateral 3 digits
• No hand of benediction
• Still have normal wrist flexion, finger flexion, and pronation

Question 21

Ulnar Nerve Lesion at Elbow

Answer 21

• Medial epicondyle fracture
• Some weakening of wrist flexion
• Loss of hypothenar muscles, third and fourth lumbricals, all interossei and adductor pollicis
• Sign is “claw hand”
• Sensory loss on medial digits and hypothenar eminence

Question 22

Ulnar Nerve Lesion at Wrist

Answer 22

• Medial epicondyle fracture
• Loss of hypothenar muscles, third and fourth lumbricals, all interossei and adductor pollicis
• Sign is “claw hand”
• Sensory loss on medial digits and hypothenar eminence

Question 23

Upper Plexus Injury

Answer 23

• “Erb-Duchenne Palsy”
• C5/C6 Root nerves
• Falling on neck & shoulder
• “Waiter’s Tip”

Question 24

Lower Plexus Injury

Answer 24

• Klumpke’s Palsy
• C8/T1 Root nerves
• Catch yourself falling on a tree limb
• “Claw hand” & “Ape hand”