UL Clinicals II

Comprehensive vocabulary flashcards covering upper limb clinical correlations, nerve injuries, and hand deformities based on lecture notes.

Nerve of Bell Injury

Also known as the nerve to serratus anterior; injury results in winging of the scapula and loss of overhead abduction and punching/pushing.

Causes are sudden pressure on shoulder from above and carrying heavy loads.

Poland syndrome

A condition characterized by the absence of both pectoralis major and minor muscles, breast hypoplasia, and the absence of ribs 2 to 4.

Triangle of Auscultation

A region bounded by the trapezius, scapula, and latissimus dorsi where respiratory sounds are best heard through a stethoscope.

Thoracodorsal nerve injury

Results in paralysis of the latissimus dorsi, making a person unable to raise their trunk during climbing or use an axillary crutch.

Musculocutaneous nerve injury

weakness of supination (biceps) and flexion (biceps and brachialis) and loss of sensation over the lateral side of the forearm.

Popeye's deformity

A ball-like appearance near the center of the arm caused by the rupture of the biceps tendon in the intertubercular sulcus.

Median cubital vein

The preferred vein for intravenous injection, cardiac catheterisation, and withdrawing blood; if absent, the basilic vein is preferred.

Which vein is used for central venous line placement?

Axillary vein

Which veins are commonly used for long-term intravenous access?

Dorsal venous network, cephalic vein, and basilic vein (near their origin)

for administration of fluids, medications, and intravenous feeding.

Musician's nerve

A common name for the ulnar nerve because it controls the fine movements of the fingers.

Cubital tunnel syndrome

Compression of the ulnar nerve in the cubital tunnel behind the medial epicondyle (funny bone).

Results in paralysis of flexor carpi ulnaris and medial half of flexor digitorum profundus, flattening of the medial side of forearm, flexion resulting in abduction, loss of flexion of terminal phalanges of ring and little finger.

Ulnar claw-hand

A deformity from wrist-level ulnar nerve lesions involving hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints of the ring and little fingers.

Little finger held in abducted position by extensors.

Ulnar paradox

Ulnar injury at wrist makes more prominent claw hand because flexor digitorum profundus is spared which flexes the interphalangeal joint. (If lesion it at elbow, profundus gets denervated and can’t flex the interphalangeal joint)

“the closer to the paw, the worse the claw”

Ulnar nerve lesion sensory and motor loss and vasomotor changes

Sensory loss: Medial one-third of the palm and medial 1½ fingers, including their nail beds (if lesion at wrist).

Motor loss: Paralysis of the dorsal (they waste away), loss of adduction of thumb, loss of flexion of medial two fingers.

Vasomotor changes: Warm, dry and scaly skin. In chronic, brittle, cracked nails with atrophy of finger pulps.

Froment's sign

Also called the book test; used to evaluate the adductor pollicis muscle to exclude ulnar nerve injury at the wrist.

High origin superficial ulnar artery

Can be mistaken for a vein during drug injection causing severe arterial spasm and gangrene, potentially partial or complete loss of the hand.

Labourer's nerve

A name for the median nerve because it controls coarse hand movements and supplies most of the long muscles of the forearm.

Pointing index finger or Benediction hand or Pope’s hand

A sign of median nerve injury above the elbow where the index and middle fingers remain straight while the patient attempts to make a fist.

Ape or monkey thumb deformity

A condition resulting from the paralysis of thenar muscles due to median nerve injury. Thumb remains adducted and cannot be rotated.

Median nerve injury at elbow

Paralysis of flexor pollicis longus, lateral half of flexor digitorum profundus, pronator muscles, flexor carpi radialis

results in adduction and of hand (due to unopposed flexor carpi ulnaris), supination and loss of flexion at distal interphalangeal joints of lateral two fingers and thumb and weak flexion of wrist.

Carpal tunnel syndrome

Median nerve compression at the wrist resulting in an ape-like hand, loss of thumb opposition, and sensory loss on the lateral $3 \frac{1}{2}$ digits.

Anterior interosseous syndrome

A condition where a person cannot oppose thumb and index finger to make an 'okay' sign, resulting in a pinch posture due to lack of flexion in the distal interphalangeal joints.

Due to injury of anterior interosseous nerve causing paralysis of flexor pollicis longus and flexor digitorum

Pronator syndrome

Compression of the median nerve between the heads of the pronator teres due to trauma or hypertrophy, causing forearm pain and sensory loss in the radial $3 \frac{1}{2}$ digits. Repeated pronation occurs.

Complete claw hand

Both ulnar and median nerve injured

Saturday night palsy or Crutch paralysis

Radial nerve injury in the radial groove caused by pressure, such as sleeping with a limb hanging over a chair or using crutches, resulting in wrist drop.

Also injured by IM injections in triceps and fracture of humeus at mid shaft.

Wrist drop

Loss of function of extensors of wrist, metacarpals and phalanges in forearm due to radial nerve injury causing wrist to drop. Weakness of abduction and adduction of hand.

Medial head of triceps is affected.

Loss of sensation on lateral side of dorsum of hand and a narrow patch on back of forearm.

Allen test

A procedure used to test for the occlusion of the radial or ulnar arteries by observing the return of color to the palm after clenching the fist.

Guyon's canal syndrome

Entrapment of the ulnar nerve in the ulnar canal, causing numbness and tingling in the ring and little fingers followed by loss of sensation and motor weakness. Treated by surgical decompression of ulnar nerve.

(Guyon’s canal (ulnar tunnel) is formed by the pisiform, hook of the hamate, and pisohamate ligament. It lies deep to the palmaris brevis muscle and the palmar carpal ligament and transmits the ulnar nerve and ulnar artery.)

Handlebar neuropathy

Sensory loss and intrinsic muscle weakness in the hand caused by pressure on the hook of the hamate during long-distance cycling.

Dupuytren's contracture

A progressive fibrosis and shortening of the palmar fascia that pulls the fingers (especially the third and fourth) into a flexion deformity.

Treated by surgicial excision of all fibrotic parts.

Volkmann's contracture

An ischemic muscular contracture of the fingers and wrist caused by necrosis of the flexor muscles following compartment syndrome or a tight cast.

Raynaud syndrome

A condition involving ischemia and cyanosis of the digits accompanied by pain due to anatomical abnormalities or underlying disease.

Tenosynovitis

Inflammation of a tendon and its synovial sheath; in the thumb (radial bursa) and little finger (ulnar bursa), infection can spread to the forearm. Puncture injuries cause infection.

Trigger finger

Stenosing tenosynovitis where a nodule on the flexor tendon causes audible clicking or snapping during joint movement resulting in joint pain.

Caused by rheumatoid arthritis, diabetes, repetitive trauma, and age-related wear and tear of the tendon. Treatment includes immobilization with a splint, corticosteroid injection into the flexor tendon sheath to shrink the nodule, or surgical incision of the thickened area.

Mallet finger

Also called baseball finger; a permanent flexion of the distal phalanx caused by the avulsion of the lateral bands of the extensor tendon.

Hammer finger

Also called Boutonniere deformity; abnormal flexion of the middle phalanx and hyperextension of the distal phalanx due to an avulsion of the central band of the extensor tendon or rheumatoid arthritis.