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When angle between neck and shoulder is greatly increased
When do superior brachial plexus injuries occur?
Erb-Duchenne palsy
Term used to refer to muscle weakness as result of damage to the superior trunk, or C5-C6 anterior rami
C5-C6 anterior rami or superior trunk
Damage to what anterior rami or trunk causes Erb-Duchenne palsy?
Fall from a horse or motorcycle or delivery problems at birth
What typically causes damage to the superior brachial plexus, or Erb-Duchenne palsy
Paralysis of shoulder and arm muscles supplied by them, causing an adducted shoulder, medially rotated arm, and extended elbow, as well as loss of lateral arm sensation
What does damage to the C5/C6 anterior rami, or the superior trunk, cause?
less
Inferior brachial plexus injuries are more/less common that superior brachial plexus injuries
Klumpke paralysis
Injuries to the inferior brachial plexus are broadly known to cause what is referred to as...
Superior pulling on upper limb, such as when breaking a fall or pulling on arm in delivery
What can cause lower brachial plexus injuries, or Klumpke paralysis?
Avulsion of the spinal roots from the spinal cord
What is one injury that can occur to C8-T1 anterior rami, or the inferior trunk?
Short muscles of hand can't contract, which causes a "claw hand" position when attempting to contract the fingers
What symptoms are associated with avulsion of the roots of the C8-T1 spinal nerves?
Late fusion of epiphysial plate at sternal end with main shaft of clavicle or a failure of the two ossification centers in the shaft to fuse (appears like a fracture)
What two areas of the clavicle can cause confusion on imaging?
Surgical neck
Where do fractures in the humerus typically occur?
Hard fall on shoulder or outstretched limb
What can cause dislocation of the AC (acromioclavicular) joint?
Tearing of AC and coracoclavicular ligaments
One type of AC (acromioclavicular) joint dislocation is referred to as "shoulder separation". What has occurred in this AC joint dislocation?
inferiorly
When the glenohumeral joint dislocates, it typically does so...
Anterior and posterior dislocation
Clinically, what are the two types of inferior dislocation of the glenohumeral joint?
Anterior dislocation
What type of glenohumeral joint dislocation is much more common?
Position of joint relative to long head of triceps
What determines whether a glenohumeral joint dislocation is anterior or posterior?
Ripping of joint capsule and labrum and damage to axillary nerve
In a glenohumeral joint dislocation, what can commonly occur?
Loss of sensation to superolateral arm; impaired flexion/extension and medial and lateral rotation of arm; and inability to abduct arm past 15 degrees
In a scenario where dislocation to the glenohumeral joint occurred and the axillary nerve were severed, what would be the symptoms experienced?
Repetitive use of upper limb above horizontal
What typically causes a rotator cuff injury?
Supraspinatus
What muscle is most commonly injured in a rotator cuff injury?
Abduct first 15 degrees, passively abduct arm past 15 degrees so middle deltoid can take over
If a rotator cuff injury occurs, specifically to supraspinatus, what action can one not do and how is it compensated?
Adhesive capsulitis of glenohumeral joint
Clinical term that refers to a "frozen shoulder"
Adhesive fibrosis and scarring occurs between the joint, rotator cuff, bursa, and deltoids
What occurs in adhesive capsulitis of the glenohumeral joint?
Inflammation, dislocation, and bicipital tendinitis
What are some common symptoms with adhesive capsulitis of the glenohumeral joint?
Abduction of arm; elevation and rotation of the scapula
What movement in particular is hard to perform with adhesive capsulitis of the glenohumeral joint? How is it compensated?
Paralysis of serratus anterior
Clinical terminology for a "winged scapula"
Damage to the long thoracic nerve
What can cause paralysis of serratus anterior?
The medial border of the scapula move laterally and posteriorly away from the thoracic wall, as serratus anterior no longer holds it against it
What occurs if damage to the long thoracic nerve occurs?
Abduction past horizontal position; serratus anterior cannot rotate the glenoid cavity to allow the motion
What is a movement that cannot occur with paralysis of serratus anterior? Why?
Superolateral quadrant
Where is carcinoma of the breast most common?
Age, hormones, and pregnancy/nursing
What physiological factors have an impact on the breast?
Adenocarcinoma
What is the most common cancer of the breasts?
Epithelium of lactiferous ducts
In adenocarcinoma of the breasts, what tissue is affected?
When a tumor presses against the suspensory ligaments
What causes dimpling of the breasts?
Abnormal contours or orange peel appearance
What does edema in the breast cause?
Colles fracture
Complete transverse fracture of the distal end of the radius
Forced dorsiflexion of hand, usually from a fall
What typically causes a Colles fracture?
comminuted
The broken fragment in a Colles fracture is often ________________, or broken into many pieces
dinner fork deformity
Colles fracture typically causes a ________________, which is characterized by a posterior concavity near the wrist caused by anterior displacement of the radius by the distal fragment
Anterior displacement of the radius by the distal fragment of it
What causes a dinner fork deformity in a colles fracture?
Athletic throwing movements
What typically causes damage to the ulnar collateral ligament?
Surgical reconstruction (Tommy John procedure) with a long tendon from contralateral forearm or leg (palmaris longus or plantaris)
How is the ulnar collateral ligament repaired?
Radial head dislocation
What is "nursemaid's elbow"?
Sudden lifting of a child by the upper arms
What can cause radial head dislocation, or transient subluxation of the radial head?
Tearing of distal attachments of anular ligament and trapping of proximal attachments between capitulum and radial head
What can occur in a radial head dislocation?
Preschool children, especially girls
In what individuals is a radial head dislocation most common?
Placing in sling for 2 weeks
What is the treatment for a radial head dislocation?
Elbow tendinitis
What is "tennis elbow"?
Inflammation form repetitive use of the superficial extensors causing strain to the common extensor tendon
What causes elbow tendinitis?
Lateral epicondyle and radiates along posterior forearm
Where does pain occur in elbow tendinitis?
Surgical intervention
What may be needed if the common extensor tendon is torn?
True
T/F? Fractures can occur in any of the 27 bones of the hand or wrist
Fall with hand abducted
What most commonly causes scaphoid fractures?
lateral wrist
Scaphoid fractures are accompanied with pain in the...
poor
The scaphoid bone has poor/good blood supply
Bone resorption (destruction of bone tissue), prolonged healing, and a chance for avascular necrosis
If the scaphoid is fractured, what can occur due to its relatively poor blood supply?
Degenerative joint disease in the wrist
If avascular necrosis occurs following a fracture of the scaphoid, what may develop?
Ulnar canal syndrome
Caused by compression of the ulnar nerve at the ulnar canal
Hypoesthesia of 5th and medial 4th digits and weakness of intrinsic hand muscles
What are symptoms characteristic of ulnar canal syndrome?
"handlebar palsy"
Ulnar canal syndrome is sometimes referred to as ______________ because it can occur due to compression of the ulnar nerve against handlebars of a bicycle
Reduction in size of carpal tunnel, putting pressure on the median nerve and its branches, leading to lesions, infection, or inflammation
What causes carpal tunnel syndrome?
Tingling and diminished sensation in lateral 3.5 digits and progressive loss of function/weakness of thenar muscles
What symptoms are characteristic of carpal tunnel syndrome?
They are innervated by the recurrent branch of the median nerve
What does progressive loss of coordination and weakness of the thenar muscles occur in carpal tunnel syndrome?
is not; palmar cutaneous branch of the median nerve branches off prior to the carpal tunnel
Central palm sensation is/is not affected by carpal tunnel syndrome. Why?
Carpal tunnel release, or surgical cutting of flexor retinaculum to relieve pressure
How is carpal tunnel syndrome treated?
Progressive shortening, thickening fibrosis of palmar fascia leading to degeneration of fibrous bands on medial side of palm
What is dupuytren contracture?
Partial flexion of 4th and 5th digits at MCP and PIP joints
When degeneration of fibrous bands on the medial side of the palm occurs with dupuytren contracture, what occurs in the hand?
Thoracic outlet syndrome
Condition that takes on many forms and is caused by the compression of typically nerves, arteries, or veins passing through the superior thoracic aperture
Neurogenic (90% of cases)
What is the most common form of thoracic outlet syndrome?
Arterial
What type of thoracic outlet syndrome is costoclavicular syndrome?
Compression of subclavian artery between clavicle and 1st rib
What causes costoclavicular syndrome?
Pallor and coldness of upper limb and diminished radial pulse
What are the symptoms of costoclavicular syndrome?
Cervical rib arising from the 7th vertebra
What is the most common cause of thoracic outlet syndrome?