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CLINICAL CORRELATES 6-10
Clinical Correlates from Dr. White's book
62
Anatomy
11/12/2006

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Term
Rotator Cuff Inflamation: 1) What muscle tendon is most commonly affected? 2)What motion is painful?
Definition
1)SUPRASPINATUS is most commonly affected. 2)Pain when arm is ABducted.
Term
Fracture of the Clavicle: 1) Where? 2) What nerves are at risk?
Definition
1) Site of fracture: btwn middle third and lateral third.
2)The ventral rami of C8 and T1 may be lacerated.
Term
Shoulder Trauma may cause SUBLUXATION of the acromium at the acromioclavicujlar joint. Which ligament prevents dislocation of the acromioclavicular joint?
Definition
The Coracoclavicular ligament
Term
Humeral Dislocation: 1)Where does the humerus get displaced to? 2)What nerves are at risk?
Definition
1) Humerous is displaced inferiorly and anteriorly, inferior to coracoid process. 2) The AXILLARY and RADIAL nerves maybe stretched.
Term
Humeral Fracture: What is at risk? 1)Surgical Neck. 2)Greater Tubercle. 3)Midshaft. 4)Supracondylar.
Definition
1)Surgical Neck:Axillary Nerve and Poosterior Humoral Circumflex artery.
2)Greater Tubercle: SITS muscles can get detached. 3)Midshaft: Radial Nerve and Deep Brachial Artery. 4)Supracondylar: Median Nerve.
Term
TENNIS ELBOW:
1) Which eipcondyle? 2) What Tendon?
Definition
1) Lateral Epicondyle. 2)Common Extensor Tendon from forced extension and flexion.
Term
GOLFER'S ELBOW: 1) Which eipcondyle? 2) What Tendon?
Definition
1) Medial Epicondyle. 2)Common FLEXOR Tendon from repetitive flexion and pronation.
Term
What nerve is at risk if you fracture the MEDIAL epicondyle of the humerus?
Definition
Ulnar Nerve.
Term
A patient presents with a Colles' Fracture of the distal radius. 1)What can be avulsed? 2)What deformity may be observed?
Definition
1) The STYLOID process of the shaft of the radius may be avulsed. 2)Dinner Fork Deformity= posterior displacement of distal radius.
Term
What carpal bone is most commonly dislocated? What may this cuase?
Definition
Dislocation fo the Lunate may cause CARPAL TUNNEL syndrome.
Term
What is the most commonly FRACTURED carpal bone? Where will the patient feel pain? What is a potential complication of this?
Definition
Patients with a SCAPOHID fracture may experience pain over the snuff box. The proximal part of the scapoid may undergo avascular necrosis (blood supply to DISTAL and then proximal).
Term
The 1st or 2nd part of the AXILLARY artery is occulded. Which branches of the SUBSCAUPLAR artery contribute to collateral circulation?
Definition
THe circumflex scapular(TRIANGULAR SPACE) and thoacodorsal arteries.
Term
Volkman's Ischemic Contracture may be caused by a supracondylar fracture of the humerus, which compresses the ______ artery.
Definition
Brachail Artery. The hand is sverely flexed at the wrist and the fingers are flexed at the IP joints.
Term
If the palmar aponeurosis shortens, then which 2 fingers are flexed?
Definition
RING and LITTLE finger are shortened dudring DUPUYTREN's contracture.
Term
Which nerves from the brachial plexus contain ANTERIOR division fibers? What is their primary action?
Definition
Musculocutaneous, Ulnar, Median, Pectoral nerves. They are FLEXORS.
Term
Which nerves from the brachial plexus contain POSTERIOR division fibers? What is their primary action?
Definition
Axillary, radial, all 3 subscapular. These are EXTENSORS.
Term
Upper Brachial Plexus Injury= Erb-Duchenne Syndrome. 1)What nerve roots are lesioned? 2)What is the "position" of the arm? 3)what actions are weakened? 4)What muscles are UNaffected?
Definition
1)C5/C6. 2)Waiter's Tip positon. 3)loss of abduction and weakness of flexion/lateral roataion at GH joint. Elbow flexion, supination can be weakened. 4) RHOMBOID, Levator Scapulae and Serratus Anterior are unaffected [dorsal scapular and long thoracic nerves branch proximal to the lesion].
Term
Lower Plexus Injury: Klumpke's Paralysis. 1)What nerves are lesioned? 2)Which muscles that act at the shoulder/Elbow are effected? 3)What can't the patient do?
Definition
1) Median and Ulnar Nerves. 2) NONE!. 3)Pt. can't make a FIST:MP, IP flexors weak. Note:Can also be caused by tumor in apical lung or cervical rib.
Term
SUPRASCAPULAR nerve lesions:
1) What bony structure does it course through? 2)What does Army Navy mean?
Definition
1)Suprascapular Notch. 2)Army on the bridge, navy under the bridge, Suprascapular ARTERY runs over the notch, nerve is UNDER the ntoch.
Term
Surgical procedures of the axilla, may lesion the ___ nerve?
Definition
Thoracodorsal nerve. Patient can't use Lat Dorsi to do things like pull-ups. Accodring to Christine, "C6, C7, C8 helps you climb the gate."
Term
Winged Scapula is caused by lesion of ______?
Definition
Long Thoracic Nerve. Patients have difficulty raising arms above head because serratus anterior helps to abduct arms greater than 90 degrees.
Term
Carpal Tunnel Syndrome: The ______ nerve is lesioned as it passed through the ________ between the flexor tendons and flexor retinaculum.
Definition
Median N. Carpal Tunnel. Patietns experience numbness and pain over palmar thumb, index and middle fingers. The Thenar muscles might be weakened.
Term
The median nerve may be lesioned just proximal to the cubital fossa, where it passes through the 2 heads of the _______ muscle?
Definition
The median nerve passed through the 2 head sof the pronator teres. Patients will have problems flexing the: Thumb, PIP/DIP of digits 2 and 3, and PIP joints of digits 4 and 5.
Term
Hand of Benediction
Definition
[image] THe index and middle fingers are extended when patient makes a fist
Term
The million dollar nerve is...
Definition
Recurrent branch of the median nerve. It supplies the thenar muscles, which allow us to grip things with our thumbs. Otherwise we are like monkeys.
Term
A patient can't make the letter O by touching his thumb and index fingers. Which nerve has been compressed? How do you know this?
Definition
The Anterior INterosseus branch of the MEDIAN nerve supplies:
Flexor Pollicis Longus, Pronator Quadratus and half of the FDP(digits 2 and 3). Patients can't make the letter O by touching their tumb/index finger (FPL and FDP). Patients may have a weakness in flexion of DIP joints of fingers 2/3.
Term
A patient has a claw hand and can't hold a piece of paper between adjacent fingers via adduction. What nerve is lesioned?
Definition
Ulnar Nerve Lesion at WRIST, the medial 2 lumbricals that flex at MP joints/extend at IP joints are weak. The interosseus and adductor pollicis muscles are weak, no abduction adduction.
Term
A patient has wrist drop, waht nerve was lesioned?
Definition
Radial Nerve, wristdrop is characterized by the inability to extend the hand at the wrist and loss of extsion at teh MP joint of all digits. The deep radial nerve supplies the extensors.
Term
Avascular Necrosis of the neck of the femur during fracture is a result of disruption of the __________ artery?
Definition
medial circumflex femoral artery (a branch of the profunda femoral artery)
Term
In which direction is the femur usually displaced?
Definition
Posteriorly, causes shortening and medial rotation of the thigh by the gluteus medius and minimus. This may compress the sciatic nerve, resulting in posterior thigh, letg and food. This also causes parathesia in the plantar foot.
Term
Knee: Terrible Triad[image]
Definition
1) Tibial Collateral Ligament. 2) Medial meniscus. 3) ACL.

LATERAL BLOW TO KNEE: tibial collateral ligament and medial meniscus may be torn.

ANTERIOR BLOW TO KNEE: ACL tear= anterior drawer sign.
Term
what type of ankle fractures are most common and why?
Definition
Inversion Ankle Sprains becasue the lateral ligament is weaker than the deltoid ligament.
Term
The medial/lateral circumflex femoral, inferior gluteal and first perforating artery contribute to cruciate anastomostis in the posterior thigh. These are important for collateral circulation if the __________ is blocked.
Definition
Femoral Artery
Term
An abscess of the psoas major in the abdomen may cause damange to the ________ nerve.
Definition
Femoral nerve, patients have weakness in flexing thigh at hip and extending leg at knee.
Term
Suzie May had 13 kids and was undergoing elective varicose vein removal so that she can wear those mini skirts to work again... what nerve may be lesioned?
Definition
The saphenous Nerve is at risk. Saphenous nerve is the LONGEST branch of the femoral nerve and it is the only branch of the lumbar plexus to cross the knee joint. it courses with the great saphenous vein and innervates the medial side of the leg and foot.
Term
The oberterator nerve passes through the ____ (hole) and the _____ (muscle) into the medial thigh to innervate adductors and flexors of the thigh.
Definition
obetrator nerve (L2-L4) emerges from medial side of psoas major and passes through the obturator foramen and obturator extrunus. It is the lumbar plexus' ANTERIOR analog of the Femoral nerve, both have L2, L3 and L4 fibers.
Term
The lateral femoral cutaneous nerve innervates skin of the lateral leg. IT may be compressed as it passes posterior to the ___________, medial to the ASIS.
Definition
[image] Inguinal Ligament
Term
Mike Russo was rushing to get to a smoking ban press conference, while he was leaving, he had trouble rising out of his chair in reunion hall and then trouble running up the stairs. What nerve has he lesioned?
Definition
The GLUTEUS MAXIMUS is the muscle, the inferior gluteal nerve is the lesion.
Term
Aaron was very excited to be volunteering at UCHC and was ready to give his first intramuscular injection, but he was worried about hitting the _________ nerve>
Definition
SCIATIC [image]
Term
Tibial Nerve Lesion in the Gluteal Region:
weakness in ______ at knee and _____ at ankle.
Definition
Flex leg at knee (hamstrings), planarflex at ankle (posterior leg).
Term
Trasal Tunnel Syndrome causes pain in the sole of the foot, due to compression of what nerve as it passes to the medial maellous?
Definition
Tibial Nerve
Term
What is the nerve most frequenty lesioned in the lower limb?
Definition
Common Fibular
Term
explain foot drop, please.
Definition
loss of dorisflesion at ankle and eversion, have steppage gait in which the affected leg is raised high off the ground and then the foot SLAPS on the group when walking
Term
if the _______ nerve passes through the piriformis, instead of anterior to it wtih the tibial nerve, piriformis syndrome results.
Definition
COMMON FIBULAR
Term
Karen was painting her toenails and realized that her sharp scizzors had fallen out of her kaboodle and cut her right in the webbed space between her great toe and second toe. She had no pain, what nerve supplies this area? Where can it be compressed?
Definition
the deep fibular nerve innervates the anteior leg msucles adn the dorsum of the foot, it can be compressed in teh anterior compartment of the leg.
Term
Dr. Kessler called me and told me to study spina bfidia. Occulta, Cystica, meningocele, meningomyelocele, myeloschesis.
Definition
Occulta(asymptomatic, tuft of hair), Cystica(cyst through arch, elevated alphafetoprotein), meningocele (cyst has meninges and CSF), meningomyelocele(lumboscarcal cord is in cyst, bladder, bowel and lower limb weakness), myeloschesis (nerual tube doesn't close, dorsal midline is exposed).
Term
Andrea had a bad headache and went to the ER for a CT, but brain bleeds are missed 5% of the time. Dr. Reyes insisted on an LP- from superficial to deep, what will the needle traverse?
Definition
Skin, fascia, supraspinous and interspinous ligaments, intralaminar space, epidural space, dura, arachnoid.
Term
if the LP is off the midline, the _______ will be traversd instead of the supra/interspinous ligaments?
Definition
Ligamentum Flavum
Term
Herniated NP at cervial vertebrae between C6 and C7 will compress which nerve? What fingers will be paralyzed? Where will the patient have pain?
Definition
C7 spinal nerve compression causes shouldner, neck pain and paresthesia in the index, middle fingers (median nerve) causes neck, shoulder pain
Term
A herniated NP between C8 and T1 will affect....
Definition
The C8 spinal nerve, which is a major component of the ULNAR nerve, the ring and little fingers of the hand will be affected. Also the hypothenar and interossous muscles of the hand will be affected.
Term
Spondylosis and Spondylolisthesis are fractures of the isthmus- what is the difference between them?
Definition
In Spondylosis, the "scottie dog" is wearing a collar, there is no anterior displacement of the vertebral body.
Term
Compression of L5 spinal roots compresses which major nerve?
Definition
Sciatic- Common Fibular(L4-S2) and Tibial(L4-S3). Sciatica= pain of the back through the posterior thigh into the leg and foot, pain, parethesia of anterolateral leg and foot. The Extensor Hallucis Longus and Tibialis ANterior are effected
Term
Compression of L5 causes paresthesia in anterolateral leg and dorsum of foot while compression of S1 causes pain in the....
Definition
posterolateral leg, heel and lateral side of foot, the hamstrings, gastroc and soleus are affected
Term
Jake is on his OB/GYN rotation and has to administer an epidural, where will he aim the needle?
Definition
He will aim the needle throught he sacral hiatus, which will anesthetise the cauda equina. From DHA: "during life, the sacral hiatus is closed by the sacroccygeal ligament, deep to which the epidural space of the sacral canal is filled with fatty connective tissue"
Term
what is radiculopathy? What are some causes?
Definition
compression of roots of spinal nerves in intervertebral foramina or in the vertebral canal. THe dermatome/myotome of compressed roots will be affected. Causes: Sponlyitis inflammation=bamboo spine, spondylosis(additional bone growth after degenerative changes), herniated disks.
Term
Laceration of the PENILE urethra may result in the extravation of urine into which spaces?
Definition
ALl spaces covered by Colle's fascia, penis, scrotum and deep to scarpa's fascia.
Term
What is the difference between male and femal perineal pouches?
Definition
Males: bulbourethral gands are in teh DEEP pouch. Females: Greater vestibular glands are in the SUPERFICIAL pouch.
Term
Jake is still on his OB/GYN rotation, he is performing a mediolateral episiotomy, what muscles will he cut?
Definition
Bulbospongiousus and transverse perineus.
Term
What does fibromatosis of Buck's fascia cause?
Definition
Peyroine diseas, which causes abnormal curvature of the penis and painful erections[image]
Term
What are the motor functions of the pudental nerve?
Definition
1. Voluntary Urinary and Fecal continence. 2)cotracts UG diaphragm to prevent prolapse 3)maintaines erection by contractin ischiocavernosus 5)explusion of urine/semen
Term
In prostate surgery, what nerves may be lesioned? WHat does this cause?
Definition
Cavernous nerves, which allow erection, laceration of them causes impotance. They are attached to the surface of the prostate gland.
Term
YOur neighborhood phone sex operator called and said "OH, you're making me so wet..." what nerves do this?
Definition
Pelvic Splanchnic Nerves stimulate the secretory activity of the vaginal glands and greater vestibular glands