+
Related Flashcards
Related Topics
Cards In This Set
| Front | Back |
|
*On gait of your patient you note that he leans toward left side when he walks, when he is asked to stand on right leg, his body tilts to the left side(+Trendelenburg sign).*Which muscles, nerve on which side is most likely involved?
|
 *He likely has weakness of Gluteus Medius and Minimus on Right side(Contralateral to the site that drops and ipsilateral to the side he stands), but they are more likely to ask about nerve that innervates those and could result in these manifestations and that is SUPERIOR gluteal nerve.(Remember Medium size is Superior to Minimal size :P)-Superior gluteal nerve comes from L4-S1.*When he leans toward unaffected leg side during walking =Gluteus Medius Limp/Positive Trendelenburg sign .*Contrast this with Inferior gluteal nerve damage, patient will have trouble walking up the stairs and rising from seated position, as this nerve innervates Gluteus Maximus which is responsible for extenson of the thigh at the hip and external rotation of thigh. |
|
*Patient has trouble rising from the sitting position+He has trouble climbing stairs, which muscle movements are responsible for his problems and which nerve could have been damaged?
|
*Gluteus Maximus is responsible for Extension of the thigh at hip and External rotation of thigh, it is innervated by INFERIOR gluteal nerve(L5-S1)*Remember :MAX broke up with his EX because she was INFERIOR to him.
|
|
*Guy is performing Valsava manuever(exhaling against a closed glottis), to promote vagal stimulation and thus possibly abolish Paroxysmal Supraventricular tachycardia(Vagal stimulation by valsava manuever or carotid stimulation could prevent re-entrant circuit from conducting), which muscles are responsible(Play biggest role) for Increasing intra-abdominal and intra-thoracic pressure?
|
*RECTUS ABDOMINIS muscles play the largest role in development of increased pressure in this region with valsava manuever.(No BS uw wants you to know that :))*If vagal stimulation fails you should give adenosine to patient with Paroxysmal SVT.
|
|
*Safetst site for intragluteal injection?
|
*ANTEROlateral Gluteal region (von hochstetter triangle), it is safer than superolateral region of the buttocks.(UW action)*Superomedial injection will lead to Superior gluteal nerve damage(>defect in medius and minimus, Can't abduct and thus contralateral side will drop up on foot elevation=+Trendelenberg sign),Superomedial,Inferomedial,Inferolateral injections can damage sciatic nerve, safest from these is SuperoLateral(But is not as safe as injection in Anterolateral region<They can make you choose between these 2 but if anterolateral isn't given, safest option would be superolateral)
|
|
*Describe course of Median nerve*patient can present with clawing of first 3 digits(lateral 3 digits), when he is asked to extend them he can't(Damage to distal part of median nerve will leave first 2 lumbricals unable to flex at MCP and EXTEND at PIJ and DIJ), patient can also complain of loss of sensation on palmar surface of lateral 3 and half digits(Dorsal parts of upper 2 and 3 digit is also involved as this is Exclusive sensory innervation of median nerve).*In proximal median nerve damage(Supracondylar fracture of humerus) there is loss of FLEXION of lateral(First 3 fingers, same ones that can't extend in distal median nerve injury,creating claw), here we recieve Pop's blessing( When you want to fight someone you can't make fist and hit them, instead you BLESS them:))*THENAR atrophy is common finding with median nerve damage.
|
 *Median nerve in arm runs with brachial artery in groove between Biceps brachii and brachialis muscles than it enters forearm trough median antecubital fossa and runs between humeral and ulnar heads of pronator teres then it runs between flexor digitorum profundus and flexor digitorum superficialis before it enters wrist in carpal tunnel(can be compressed here under flexor retinaculum which lipits expansion of carpal tunnel >Carpal tunnel syndrome<Acute CTS Can be caused by Dislocation of LUNATE, mind that lunate dislocation often leads to fracture of scaphoid located just lateral to it, so patient can be at risk of avascular necrosis of proximal scaphoid.) |
|
*Course of radial nerve?(uw wants you to know that)
|
*Comes from C5-T1 spinal nerves.*Radial nerve initially courses medial to surgical neck of the humerus(Site where axillary nerve,Posterior circumflex Artery are often injured) inferior to teres Minor, within axilla before entering posterior arm to course between long head of triceps and posterior humerus.*Ill-fitting crutch,sleeping with extended hand on chair, can result in radial nerve compression, Damage at MIDshaft of humerus is common, either way damage to radial nerve>Wrist drop(Denervation of extensors of forearm,wrist and fingers).
|
|
*Pelvic surgery, with lymph node dissection.*Now patient can't aDDuct the thigh.
|
**Obturator nerve damage(L2-L4).(anterior branch supplies GPA-Gracilis,Pectineus,Adductor Longus and Brevis, posterior branch innervates obturator Externus and adductor magnus), very characteristically with Obturator nerve damage we see Loss of sensation over MEDIAL thigh, note obturator nerve is frequently damaged with ANTERIOR hip dislocations.*If Thigh FLEXION and Leg Extension were compromised then you would have thought about FEMORAL nerve damage(L2-L4)-Femoral nerve innervates anterior thigh muscles-Quadriceps(leg extention),Sartorius,Pectineus(Accessory flexors of the hip), Sensory deficit would involve Anterior Thigh and Medial Leg.
|
|
*Guy who spends lot of time on his knees(like roofer,plumber,carpet layers) complains of pain in knee region/trouble flexing the knee(Thus he also can't kneel), he tells you that symptoms get better with rest.On physical exam you note fluctuant edema over lower pole of the patella on affected knee, +swelling,redness ,Tenderness to palpation,erythema,crepitance in the affected region.Most likely bursa involved?
|
*Prepatellar bursa diminish friction and ensure maximal movement at the knee,chronic trauma due to excessive kneeling can cause prepatellar bursitis>"Housemaid's knee"<Uw not just me lol.
|
|
*Patellar ligament spans from patella to tibial tuberosity it is continuation of?NO BS uw has it :)
|
 *Quadriceps femoris tendon.*Quadriceps femoris muscles include vastus medialis,lateralis,intermedius and rectus femoris, all quadriceps muscles are powerful extensors while rectus femoris is also a flexor.*Damage to patellar ligament could>Difficulty with leg extension. |
|
*PCL prevents?*Note that PCL attaches to inercondylar area on tibia and to femur on anterior part of medial epicondyle's lateral surface.(Shortly it extends from medial femoral condyle to posterior tibia)
|
 *PCL prevents ANTERIOR displacement of femur relative to tibia when the knee is flexed.*Know:PCL tear produces POSTERIOR drawer sign(Posterior gliding of tibia when bending knee at 90 angle)*Contrast this with ACL tear where you have Anterior displacement of TIBIA relative to femur, ACL tear gives us ANTERIOR drawer sign(Bending knee at 90 angles results in anterior gliding of tibia, if test was performed at 30 angle than it is lacham test)*uw wants you to know that ACL connects lateral femoral condyle to anteromedial tibial head.*Vignette would often describe athlete with forceful blow to lateral knee in injuries of ACL (Can give damage to MCL and Medial meniscus too)Check pic, remember Anterior and Posterior refer to Attachement to Tibia(Believe me easiset way to not fuck these up_) |
|
*Subcapsular femoral head fracturecould lead to Avascular(Aseptic) necrosis while PERItrochanteric fracture would not... why?
|
 *Because Peritrochanteric fracture is Extracapsular and doesn't compromise blood flow, while Subcapsular fracture does damage retinacular ateries of Medial femoral circumflex artery(Makes largest contribution to supplying femoral head and neck), vignette would typically describe older female with osteoporosis who fell down and now has terrible pain, damage to MFCA can lead to avascular necrosis of femoral head, Avascular necrosis itself can predispose to OsteoARTHRITIS,Fracture.*Avascular necrosis affects bone and marrow, presents with pain and can be due to Corticosteroids,Sickle cell disease(vasoocclusive crisis n bone of hands and feet which presents as dactylitis),ALCOHOLISM, Caisson'/decompression disease(Vignette would mention Diver , mechanism of avascular necrosis here is creation of Gas -Nitrogen emboli lodging into vessel>Aseptic necrosis)*Legg-calve- perthes disease(idiopathic)- childhood condition that affects the hip, usually femoral head looses blood supply, key here is that this condition is common in childhood.*They love to ask you about association of Gauchers disease (Autosomal reccessive lack of B-glucocerebrosidase, characterized by macrophages with crumpled tissue paper appearance) with avascular necrosis of femur leading to erlenmeyer flask deformity*Slipped capital femoral epiphysis can cause avascular necrosis and can present with pain in groin region that radiates to sensory distribution of obturator nerve(Medial thigh), here we basically have a fracture through the growth plate (physis), which results in slippage of the overlying end of the femur (epiphysis). Normally, the head of the femur, called the capital, should sit squarely on the femoral neck. Abnormal movement along the growth plate results in the slip. The femoral epiphysis remains in the acetabulum (hip socket), while the metaphysis (end of the femur) moves in an anterior direction with external rotation, condition often involves both lower extremities.*Note Superior and inferior gluteal arteries and lateral/medial collateral circumflex arteries contribute to trochanteric anastomosis that supplies head and neck region of the femur.(MCL is most important though) |
|
*Abnormal prominence of inferior scapular angle is observed on one side when patient pushes against the wall with both hands.(Medial border and inferior angle sticks out posteriorly like a bird's wing when patient presses anteriorly against wall)*Muscle and nerve involved?
|
*Serratus anterior paralysis due to damage to Long thoracic nerve(C5-C7) produces characteristic winged scapula.*Serratus anterior fixes scapula against posterior chest wall and rotates the scapula to allow aBduction of the arm over head.*Patient would present with difficulty lifting,pushing and pulling heavy items.*NOTE:Long thoracic nerve can be damaged in Axilla/Lateral Thorax and they love to ask you about artery that most likely was injured too-LATERAL thoracic ARTERY can be damaged here too.
|
|
*Patient can't adduct/extend humerus if it is due to damage to thoracodorsal nerve, which muscle is most likely responsible for these findings?
|
*Lattisimus dorsi muscle is innervated by thoracodorsal nerve and is responsible for adduction and extension humerus.No bs Uw has it :)*Thoracodorsal nerve comes from posterior cord.
|
|
*Stuff uw wants you to know about teres major?
|
*That teres major is NOT part of rotator cuff muscles.*Teres major is innervated by Subscapular nerve, this muscle Medially rotates the arm and aDDucts it.*Contrast this with Teres Minor which is innervated by axillary nerve and serves to aDDuct and laterally rotate the arm.
|
|
*Function of Rhomboid major?
|
*Draws the scapula medially at its border.*It is innervated by Dorsal scapular nerve<Uw wants you to know that don't get mad at me :P
|
