this is a tribute to an extraordinary handstanding, plane flying, carpal tunnel releasing surgeon
How many carpal bones are there?
8 (two rows)
Proximal row of carpals (from lateral-->medial)
Distal row of carpals (from lateral-->medial)
What articulation allows movement of the elbow to flex/extend forearm?
Monoplanar hinge joint between olecranon (of ulna) and trochlea (of humerus)
Does the ulna-humerus joint allow rotation?
No, ulna cannot rotate
What joint at the write connects the forearm to the hand?
The joint between Radius and carpal bones
What are the joints that connect the radius and ulna?
Proximal and distal radio-ulnar joints
What is the membrane between the radius and ulna?
What joins the carpal and metacarpals bones?
Where does the hand articulate with the fingers?
metacarpo phalangeal joint (MP joints)
What are the joints between the phalanges?
interphalangeal joints (IP joints)-->proximal (PIP) and distal (DIP)
Proximal radio-ulnar joint, connect radius and ulna at elbow
Is there a PIP in the thumb?
No, only CMC, MP, IP
How many bones are involved in the wrist jonit?
Where does the Brachial artery come from
It comes from the Axillary artery after the border of teres majot
What does the Brachial artery become in the forearm?
Branches into radial and Ulnar arteries
What structures are in the antecubital fossa?
Tendon of biceps brachi, Brachial artery, median nerve
What is lateral to the Brachial artery in the antecubital fossa?
Tendon of bicpes brachi
What is medial to the Brachial artery in the antecubital fossa?
Which palmar arch is a continuation of the ulnar artery?
The superficial (more distal) palmar arch
What are the connections from the subclavian vein?
It is joined by the internal jugular vein to form the brachiocephalic trunk (on both sides) then the right and left brachiocephalic trunks merge to form the superior vena cava
What bone is responsible for pronation/supination?
Radius rolls over ulna, since the hand is connected to the radius, the hand rotates also
What is indicative of tendernaess in the anatomical snuffbox
fracture of the scaphoid bone
articular caritlage that hold the radius and ulna (head of ulna) together at the wrist
occlude radial artery at the wrist for several minutes to cehck for the collateral circulation of the ulnar artery
What migh tbe damaged if you try to place an IV in the cephalic vein at the wrist?
What nerve is responsible for elbow extension?
What provides sensation to the dorsum of the hand?
What nerves serves most of the flexor pronator group in forearm?
What nerve supplies the thenar muscles and the radial palmar side of the hand?
What nerve supplies the instrinsic muscles of the hand?
What could be injured with a fracture of the surgical neck of the humerus?
anterior circumflex humeral artery (could cause aseptic necrosis of humerus)
What could be injured by a spiral fracture of the humerus?
what could be injured by a supracondylar fracture?
Brachial artery (could cause forearm ischemia)
What nerve can be injured as a result of a medial condylar fracture?
What deficits would you expect with a fracture of the spiral groove?
wrist drop and inability to extend arm
What nerve may be injured with a fracture of the surgical neck of the humerus?
What would a possible clinical sign of axillary nerver (C5 and C6) injury?
atrophy of the deltoid, should er is flattened in appeared, loss of sensation may occur on lateral side of arm
How do you test for deltoid function (axillary nerve function)?
Abduct against resistance starting from approximately 15degrees
Lack of sensation on the tip of the index finger indicates injury to what nerve?
Complete fracture of the distal part of the radius is most common fracture of forearm, results in what?
radius displaced dorsally and comminuted, often ulnar styloid is avulsed, clinical sign is dinner fork deformity
Lack of sensation on the little finger indicates damage to the what nerve?
what is a common site of venipuncture?
median cubital vein in antecubital fossa
Deltoid innervation (roots)
axillary nerve (C5*, C6)
Supraspinatus innervation (roots)
suprascapular nerver (C4, C5*, C6)
Infra spinatus innervation (roots)
suprascapular nerve ( C5*, C6)
Teres minor innervation (roots)
axillary nerve (C5*, C6)
Teres major innervation (roots)
lower subscapular nerve (C5, C6*)
Subscapularis innervation (roots)
upper and lower subscapular nerves (C5, C6*, C7)
Upper Brachial plexus injury (C5, C6) symptoms
paralysis of shoulder and arm, upper limb with adducted shoulder, medially rotated arm and extended elbow
Chronic microtrauma to the superior trunk of brachial plexus (carrying a heavy backpack) can produce...
motor and sensory deficits in the distribution of the musculocutaneous (coracobrachialis, biceps, brachialis) and radial nerves
Inferior brachial plexus injury less common) can result when limb is pulled supriorly, can result in
C8 and T1 inury resulting in claw hand
Best place to compress the brachial atery to control hemorrhage
near middle of atm, so ulnar and radial arteries still recieve sufficient blood through the anastomoses to supply elbow and forearm
Biceps tendinitis usually occurs from the _____ head of the biceps
long, tendon enclosed in synovial sheath, moves back and forth in the interturbercular groove can cause inflammation of the tendon
Does rupture of the biceps tendon result in complet detachment?
No it has two heads, the muscle will be displaced distally on the arm
Injusry to muscolocutanous nerve results in paralysis of _______, _____, _____, and this motion deficit
coracobrachialis, brachialis, biceps---results in decreased flexion of elbow and supination of forearm
Injury to the radial nerve superior to the branches to the triceps brachii results in
paralysis of triceps, brachioradialis, supinator and extensor muscles of wrist
When the radial nerve is injured in the radial groove, these muscles are mostly affected
posterior compartment (extensor/supinator) muscles of the forearm
What is the clinical sign of wrist drop associated with?
radial nerve injury
Lateral epicondylitis (tennis elbow)
painful musculoskeletal condition causing pain over the lateral epicondyle
Mallet or baseball finger
sudden severe tension on a long extensor tendon, results from DIP suddenly being forced into extreme flexion when tendon is attempting to extend distal phalynx, result is inability to extend DIP
Synovial cyst of the wrist
nontender cystic swelling on dorsum of hand, close to synovial sheaths, common site is the distall attachment of ECR Brevis
Dupuytren contracture of palmar fascia
progressive shortenting and thickening of fibrosis of palmar fascia and aponeuorsis, results in pulling of the 4th and 5th fingers into partial flexion at MP and PIP
Infection of the hand can result in pus accumulation in the thenar, hypothenar or adductor compartments
What innervates the lumbricals?
1 and 2 are median nerve, 3 and 4 are ulnar
How many interossei are there and what innervated them?
7, ulnar nerve
Palmar interosseus muscles do what motion of phalanges? How many are there?
ADduction (PAD), 3
Dorsal interosseus muscles are responsible for what motion of the phalanges? How many are there?
ABduction (DAB), 4
Inflammation of the tendon and synovial sheath, if cuase dby infection usually remains contained in the finger by separate synovial sheath
Superficial palmar arch
direct continuation of ulnar artery, superficial to palmar tendons
Deep palmar arch
Direct continuation of radial artery, deep to long flexor tendons
Common palmar digital arteries
come off the superficial palmar arch
Proper palmar digital arteries
come off of common palmar digital arteries (run alongside 2nd -5th fingers)
Why might it be necessary to compress brachial artery for complicated hand injury surgeries?
to maintian bloodless surgical field, many communicating branches from ulnar and radial arteries
How many tendons pass through carpal tunnel?
What is in danger of being cut in Carpal Tunnel release surgery?
the recurrent branch of the median nerve
What happens with injury to the median nerve at the wrist?
paralysis of thenar muscles and first two lumbricals, impossible to oppose the thumb and control fine movements of 2nd and 3rd digits
Median Nerve at the elbow results in
loss of flexion of the PIP, DIP and MP joints (MP becuase of nedian nerve supply to the 1st and 2nd lumbricals
Ape hand deformity
refers to deformity in which thumb movements limited to flexion and extension, median nerve injury at elbow
Possible sites of Ulnar nerve injury
posterior to medial epicondyle (most common), cubital fossa formed by tendinous arch, wrist, hand
Ulnar nerve injury at the elbow or wrist
Inability to fully flex wrist, wrist is drawn toward the radial side by FCR, difficulty to make a fist
characteristic presenation of ulnar nerve injury
Dislocation of the AC joint
AC joint is weak and easily injured, "shoulder separation" severe when both the AC and coracoclavicular ligaments are torn-->causes shoulder to separate from clavicle and fall because of weight of upper limb
Dislocation of the Glenohumeral joint
commonly dislocated (anteriorly most common) caused by excessive extension and lateral rotation of humerus, flexor and adductor muscles pull humeral head anterosuperiorly
Calcification of supraspinatus tendon
inflammation and calcification of the subacromial burse--pain and tenderness, limiation of movement of glenohumeral joint (abduction of GH joint is painful at 50-130 degress)
Rotator cuff injuries
Cannot initiate abduction, commonly injured during repetitive use (throwing and racquet sports), usually due to recurrent inflammation, commonly humeral head can impinge on coracoacromial arch
What structure lies deep to the anatomical snuff box?
What is the sensory area that is most indicative of radial nerve injury?
dorsum of hand (between thumb and index finer)
What results in greater deficit, proximal or distal nerve inury?
What is the common origin of the forearm flexor pronator group? What originates there?