LAB #7 3-5: Clinical Correlates of the Upper Limb.

LAB #7

3-5: Clinical Correlates of the

Upper Limb

Acromioclavicular Joint

Coracoclavicular ligament: Conoid & Trapezoid Part

Glenohumeral Joint

Coracohumeral Ligament

Coraco-acromial Ligament

Superior, Middle, and Inferior Glenohumeral Bands

Tendon of the Long Head of the Biceps Brachii Muscle

Transverse Humeral Ligament

Glenoid Labrum

Clinical Aspects

Dermatome TestingCutaneous

Referred Pain(reflective pain)

Subdiaphragmatic irritation- due to peritonitis, gall bladder inflammation, hepatic abscess, pleurisy or accumulations of CO2 following laser surgery is referred to the tip of the shoulder (phrenic nerve C3,4,5: subclavicular nerve C3,4)

Angina Pectoris- Radiation of pain from the thorax down the left upper limb (pain fibers associated with sympathetics from T1-T4: T1-T3 dermatomes of upper

limb)

Cutaneous

fascia

Dupuytren’s Contracture

Compartmental

Axilla- stretching of cords of the brachial plexus; compression of the axillary artery to stop profuse bleeding.

Cubital Fossa- T.A.N. from lateral to medial: tendon of the biceps, brachial artery, median nerve: care during venapuncture.

Radial and Ulnar Bursae- tenosynovitis: inflammation and distention (with pus) of synovial tendon sheaths. Infection can spread within these burae in the hand and also be limited within them to prevent spread to the rest of the hand.

Carpal Tunnel SyndromeWhat nerve is responsible for

Carpal Tunnel Syndrome?

The Median Nerve.

Osseous and Related Structures

Clavicle

What type of fracture is common with the clavicle? “Green stick” fracture

ShoulderOsseous and Related Structures

Seperation- involves injury to acromioclavicular joint. A complete seperation would be a rupture of acromioclavicular and coracoclavicular ligaments.

Bursitis- inflammation of subdeltoid or subacromial bursa.

Rotator Cuff- cuff is necessary for glenohumeral stability. Injury to any component of the cuff can lead to instability. Supraspinatus tendon can be torn while trying to lift too much or catching a heavy falling object.

Ruptured tendon of the long head of the biceps- intracapsular tendon becomes inflamed and erodes over time.

FOOSHOsseous and Related Structures

(Falls On the OutStretched Hand)

Youth: Adolescent: Elderly:

Which carpal bones are most often affected?

-Scaphoid-most often fractured-Lunate- most often dislocated

Compression SitesVascular- Arteries

Axillary artery- proximal humerus, medial surface

Brachial artery- medial to anterior humerus from above downward

Ulnar artery- distal anterior wrist lateral to pisiform

Radial artery- distal anterior radius, “snuff box”, 1st dorsal digital space

Avascular Necrosis of Scaphoid Bone

Vascular- Arteries

Vascular- Lymphatics

Lymphangitis Lymphedema

Lymphadenitis

Nerves

Tendon Reflexes

Test integrity of segmental regions of spinal cord

Biceps- C5,6 9 (mainly C5)

Triceps- C7,8 (mainly C7)

Brachioradialis- mainly C6

Erb-Duchenne’s Palsy (Erbs’ Palsy)

Nerves

Klumpke’s PalsyNerves

“Winged Scapula”Nerves

Axillary NerveNerves

Radial NerveNerves

Musculocutaneous Nerve InjuryNerves

Median Nerve InjuryNerves

Ulnar NerveNerves

Clawing of HandNerves

Tinel’s Sign/Test

What is this test used for?

To see if a nerve is irritated.

Phalen’s Test

What is this test used for?

Diagnostic test for Carpal Tunnel

Syndrome.

Finkelstein’s Test

This tests for what condition?

DeQuervain’s Tenosynovitis

Vascular- Arteries

Collateral Anastomoses

Scapular

Elbow

Hand

Anastomosis: The connection of normally separate parts. An anastomosis may be naturally occurring or it may be created during embryonic development, surgery, or trauma, or by pathological means. An anastomosis may, for example, connect two blood vessels, or it may connect the healthy sections of the colon or rectum after a cancerous or otherwise diseased portion has been surgically removed.