Upper extremity clinical correlations
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Questions and Answers

Which of the following structures is NOT found within the carpal tunnel?

  • Extensor tendons (correct)
  • Median nerve
  • Tendons of flexor muscles
  • Blood vessels

    • Which of the following symptoms is NOT typically associated with carpal tunnel syndrome?

  • Numbness in fingers
  • Tingling in fingers
  • Pain in the elbow (correct)
  • Weakness in the thumb

    • Which of the following branches of the median nerve innervates the lateral half of the skin of the index finger, middle finger, and part of the ring finger?

  • Deep branch of the ulnar nerve
  • Thenar branch
  • Proper palmar digital branch (correct)
  • Common palmar digital branch

    • Which of the following muscles are innervated by the motor branch of the median nerve?

    <p>Thenar muscles</p> Signup and view all the answers

    Which of the following statements about the flexor muscles of the hand is correct?

    <p>They play a role in grasping and manipulating objects</p> Signup and view all the answers

    Which condition presents with symptoms that are typically worse at night and while driving?

    <p>Carpal Tunnel Syndrome</p> Signup and view all the answers

    Which test can be used to assess carpal tunnel syndrome by tapping on the volar wrist crease?

    <p>Flick test</p> Signup and view all the answers

    Which condition is characterized by neck pain, reduced range of motion, gait disturbance, and loss of hand dexterity and strength?

    <p>Cervical Myelopathy</p> Signup and view all the answers

    Which of the following conditions is NOT included in the differential diagnosis of Carpal Tunnel Syndrome?

    <p>Hyperreflexia</p> Signup and view all the answers

    Which procedure sees an annual release of 10/10000 cases and approximately 400,000 procedures in the US per year?

    <p>Carpal Tunnel Release</p> Signup and view all the answers

    Which factor is directly associated with higher rates of carpal tunnel syndrome in women?

    <p>Hormonal factors and abdominal weight distribution</p> Signup and view all the answers

    How does obesity contribute to the development of carpal tunnel syndrome?

    <p>All of the above</p> Signup and view all the answers

    Which of the following health conditions is NOT mentioned as a potential contributor to carpal tunnel syndrome?

    <p>Hypertension</p> Signup and view all the answers

    What is a preventative measure recommended in the text for reducing the likelihood of developing carpal tunnel syndrome?

    <p>Maintaining proper posture and wrist alignment</p> Signup and view all the answers

    What is recommended for individuals affected by carpal tunnel syndrome?

    <p>Seeking medical attention early for better treatment outcomes</p> Signup and view all the answers

    What is the purpose of Phalen's test in relation to carpal tunnel syndrome?

    <p>To provoke symptoms of carpal tunnel syndrome</p> Signup and view all the answers

    What is the significance of Tinel's sign in diagnosing carpal tunnel syndrome?

    <p>It helps identify the exact location of the median nerve compression</p> Signup and view all the answers

    How does non-surgical treatment like physical therapy help in managing carpal tunnel syndrome?

    <p>By strengthening wrist muscles to improve function</p> Signup and view all the answers

    What role does thenar atrophy play in carpal tunnel syndrome?

    <p>It is a common complication resulting from carpal tunnel syndrome</p> Signup and view all the answers

    What impact does thenar atrophy have on daily activities of individuals with carpal tunnel syndrome?

    <p>Reduces grip and pinch force</p> Signup and view all the answers

    What is the purpose of Phalen's test in relation to carpal tunnel syndrome?

    <p>To provoke symptoms by applying pressure on the median nerve</p> Signup and view all the answers

    Which of the following is NOT a non-surgical treatment option mentioned for carpal tunnel syndrome?

    <p>Corticosteroid injections</p> Signup and view all the answers

    What is the significance of Tinel's sign in diagnosing carpal tunnel syndrome?

    <p>It helps reproduce symptoms by tapping over the median nerve</p> Signup and view all the answers

    What is the primary consequence of thenar atrophy in carpal tunnel syndrome?

    <p>Weakness in the muscles responsible for thumb abduction and opposition</p> Signup and view all the answers

    Which of the following statements about Tinel's sign and Phalen's test is correct?

    <p>Tinel's sign provokes symptoms by tapping, while Phalen's test provokes symptoms by wrist flexion</p> Signup and view all the answers

    Which of the following is a non-surgical treatment option for pronator syndrome?

    <p>Physical therapy</p> Signup and view all the answers

    What is the purpose of Tinel's sign in diagnosing pronator syndrome?

    <p>To reproduce symptoms by tapping over the affected nerve</p> Signup and view all the answers

    Which of the following structures is most commonly associated with pronator syndrome?

    <p>Flexor digitorum superficialis</p> Signup and view all the answers

    What is the significance of thenar atrophy in pronator syndrome?

    <p>It suggests compression of the median nerve</p> Signup and view all the answers

    Which of the following structures is NOT typically involved in pronator syndrome?

    <p>Ulnar nerve</p> Signup and view all the answers

    Which test can be used to assess carpal tunnel syndrome by tapping on the volar wrist crease?

    <p>Tinel's sign</p> Signup and view all the answers

    What is the primary consequence of thenar atrophy in pronator syndrome?

    <p>Decreased grip strength</p> Signup and view all the answers

    What is a common non-surgical treatment option for pronator syndrome?

    <p>Transcutaneous electrical nerve stimulation (TENS)</p> Signup and view all the answers

    What does Phalen's test help diagnose in relation to carpal tunnel syndrome?

    <p>Median nerve entrapment by fibrous bands</p> Signup and view all the answers

    What is the significance of Tinel's sign in diagnosing pronator syndrome?

    <p>Diagnosing median nerve entrapment along the forearm</p> Signup and view all the answers

    What distinguishes ulnar nerve entrapment from ulnar nerve neuropathy?

    <p>The location of the nerve compression</p> Signup and view all the answers

    Which condition is specifically linked to repetitive motions, direct trauma, or wrist pressure in the text?

    <p>Ulnar nerve entrapment</p> Signup and view all the answers

    What is a common symptom shared by both ulnar nerve entrapment and ulnar nerve neuropathy?

    <p>Numbness in the hand and fingers</p> Signup and view all the answers

    Which factor is NOT mentioned as a cause of ulnar nerve neuropathy in the text?

    <p>Repetitive motions</p> Signup and view all the answers

    How do ulnar nerve entrapment and neuropathy affect hand function if left untreated?

    <p>Lead to difficulty grasping objects</p> Signup and view all the answers

    Which of the following muscles are innervated by the ulnar nerve?

    <p>Interossei and lumbricals (except first lumbrical)</p> Signup and view all the answers

    What is a common symptom associated with ulnar nerve disorders?

    <p>Tingling or numbness in the ring and small fingers</p> Signup and view all the answers

    Which of the following conditions is characterized by weakness in the hands and difficulty performing manual tasks?

    <p>Ulnar nerve compression</p> Signup and view all the answers

    Which of the following muscles is NOT innervated by the ulnar nerve?

    <p>Flexor pollicis brevis</p> Signup and view all the answers

    Which of the following statements about the ulnar nerve is correct?

    <p>It innervates the dorsal interossei muscles.</p> Signup and view all the answers

    Which of the following is a typical symptom associated with ulnar nerve lesions at Guyon's canal?

    <p>All of the above</p> Signup and view all the answers

    What is the primary diagnostic test used to evaluate ulnar nerve lesions at the elbow?

    <p>Electromyography (EMG)</p> Signup and view all the answers

    Which of the following treatment options is typically recommended for severe ulnar nerve lesions?

    <p>Nerve decompression surgery</p> Signup and view all the answers

    What is the primary clinical manifestation of ulnar nerve lesions at the elbow?

    <p>Weakness or atrophy of the intrinsic hand muscles</p> Signup and view all the answers

    Which of the following is a potential conservative treatment option for ulnar nerve lesions?

    <p>Physical therapy and splinting</p> Signup and view all the answers

    What is the purpose of Bouvier's maneuver in evaluating compression of the radial nerve?

    <p>Identifying radial nerve compression near the axilla</p> Signup and view all the answers

    Which condition is associated with the positive presence of Fromont's Sign?

    <p>Ulnar nerve entrapment</p> Signup and view all the answers

    How does Wartenberg's sign differ from Fromont's Sign?

    <p>Forearm pronation and supination with wrist extended</p> Signup and view all the answers

    Which symptom is NOT typically associated with Ulnar Nerve Entrapment?

    <p>Index finger tingling</p> Signup and view all the answers

    In diagnosing upper extremity peripheral neuropathy, which test would be most appropriate to use among Fromont's Sign, Wartenberg's Sign, and Bouvier's Maneuver?

    <p>Fromont's Sign</p> Signup and view all the answers

    Which nerve provides sensation to the back of the hand and controls wrist extension and forearm supination?

    <p>Radial nerve</p> Signup and view all the answers

    What clinical test assesses the patient's ability to lift their wrist against gravity as a means of evaluating radial nerve function?

    <p>Wrist extension strength assessment</p> Signup and view all the answers

    Which sign involves flexing the patient's wrist for 30 seconds to identify potential carpal tunnel syndrome symptoms?

    <p>Phalen's Test</p> Signup and view all the answers

    Which test requires the patient to extend their wrists fully, and if symptoms appear in the median nerve distribution, it could suggest wrist entrapment?

    <p>Reverse Phalen's Test</p> Signup and view all the answers

    During a clinical exam, what is assessed by evaluating the patient's ability to do elbow curls against resistance?

    <p>Radial nerve innervation</p> Signup and view all the answers

    What distinguishes neurapraxia from axonotmesis in the context of radial nerve palsy?

    <p>Neurapraxia results in reversible temporary conduction blockade, while axonotmesis involves permanent nerve fiber loss.</p> Signup and view all the answers

    Which activity is most likely to increase the risk of radial nerve palsy due to compressive neuropathies?

    <p>Typing on a computer keyboard</p> Signup and view all the answers

    What distinguishes neurotmesis from axonotmesis in the context of radial nerve palsy?

    <p>Neurotmesis involves complete transection of the nerve, while axonotmesis involves temporary nerve dysfunction.</p> Signup and view all the answers

    What differentiates neurapraxia from neurotmesis in the context of radial nerve palsy?

    <p>Neurapraxia results in irreversible temporary conduction blockade, while neurotmesis represents complete transection of the nerve.</p> Signup and view all the answers

    In the context of radial nerve palsy, what is the primary characteristic of Saturday Night Palsy?

    <p>It leads to sudden onset finger flexion weakness after prolonged rest.</p> Signup and view all the answers

    What is the most common cause of radial nerve palsy?

    <p>Prolonged compression during sleep (Saturday night palsy)</p> Signup and view all the answers

    Which muscle group is most affected in radial nerve palsy?

    <p>Wrist and finger extensor muscles</p> Signup and view all the answers

    What is the most common mechanism of trauma causing radial nerve palsy?

    <p>Fracture of the humerus</p> Signup and view all the answers

    Which clinical test is used to assess radial nerve function?

    <p>Bouvier's maneuver</p> Signup and view all the answers

    What is the primary consequence of an untreated radial nerve palsy?

    <p>Wrist drop and inability to extend the fingers</p> Signup and view all the answers

    What is the common consequence of missed partial tendon injuries?

    <p>Delayed tendon rupture</p> Signup and view all the answers

    Which activity is most likely to lead to injury causing Saturday night palsy?

    <p>Carrying a heavy backpack on one shoulder</p> Signup and view all the answers

    What is the recommended treatment for distal tendon lacerations?

    <p>Stack Splint for 8 weeks</p> Signup and view all the answers

    In case of a Palmer laceration with arterial injury spouting blood, what is most likely also affected besides the artery?

    <p>Nerve injury</p> Signup and view all the answers

    What treatment would be appropriate for ECU Tendonitis in a golf player experiencing pain at the top of the backswing and follow through?

    <p>Injection of local anesthetic into subsheath</p> Signup and view all the answers

    Which of the following activities is most likely to lead to radial nerve palsy, also known as 'Saturday night palsy'?

    <p>Prolonged pressure on the radial nerve due to lying on the arm while intoxicated</p> Signup and view all the answers

    Which of the following is a common symptom associated with radial nerve palsy resulting from trauma?

    <p>Weakness in wrist extension and inability to extend the fingers</p> Signup and view all the answers

    What is the primary consequence of an untreated radial nerve palsy resulting from trauma?

    <p>Permanent muscle wasting and loss of function in the forearm and hand</p> Signup and view all the answers

    Which of the following clinical tests is used to assess radial nerve function and detect radial nerve palsy?

    <p>Bouvier's maneuver</p> Signup and view all the answers

    What is the most common cause of traumatic radial nerve palsy?

    <p>Direct trauma to the elbow from a fall or impact</p> Signup and view all the answers

    Which form of arthritis is characterized by sudden attacks of severe pain, redness, tenderness, and swelling, often affecting the big toe first?

    <p>Gout</p> Signup and view all the answers

    Which type of arthritis primarily affects adults over 50 years old due to the breakdown of protective cartilage between joints?

    <p>Osteoarthritis</p> Signup and view all the answers

    What symptom is NOT generally associated with arthritis?

    <p>Weight Loss</p> Signup and view all the answers

    Which type of arthritis is characterized by symmetrical symptoms that affect both sides of the body equally?

    <p>Rheumatoid Arthritis</p> Signup and view all the answers

    What is the primary factor determining the causes of different forms of arthritis?

    <p>Specific form of arthritis</p> Signup and view all the answers

    What is the recommended treatment for Thumb basal joint arthritis?

    <p>Surgery</p> Signup and view all the answers

    Which muscle group is responsible for maintaining the glenohumeral relationship?

    <p>Rotator Cuff Muscles</p> Signup and view all the answers

    In the context of shoulder pain, what provides the motor for arm elevation?

    <p>Deltoid</p> Signup and view all the answers

    What is the ratio of females to males affected by Cmc swelling?

    <p>1:3</p> Signup and view all the answers

    What is the most common carpal bone to be fractured in the wrist?

    <p>Scaphoid bone</p> Signup and view all the answers

    In which age group does the second peak of fracture incidence, associated with fragility fractures, typically occur?

    <p>75-85 years</p> Signup and view all the answers

    What distinguishes fragility fractures from other fractures?

    <p>They occur with minimal or no trauma</p> Signup and view all the answers

    Which condition is often linked to progressive arthritis, causing joint damage over time?

    <p>Rheumatoid arthritis</p> Signup and view all the answers

    What distinguishes bimodal distribution fractures in older individuals from those in young adults?

    <p>Association with low-energy trauma in older individuals</p> Signup and view all the answers

    Study Notes

    Overview of Median Nerve Anatomy and Function in the Human Body

    The median nerve is a major sensory and motor nerve that originates from the brachial plexus, specifically the ventral rami of C6 through C8. It is responsible for innervating various parts of the hand and wrist, including muscles and skin.

    Origin and Course

    The median nerve begins its course within the epineural sheath of the medial brachial cutaneous nerve near the musculocutaneous junction. As it descends down the arm, it passes between two heads of the triceps brachii muscle, where it enters the forearm through the anterior intermuscular septum. In the forearm, it divides into several branches, such as the anterior interosseous branch and the palmar cutaneous branch.

    Branches and Distribution

    Anterior Interosseous Branch

    The anterior interosseous branch provides motor innervation to the pronator quadratus, flexor pollicis longus, and flexor digitorum profundus. These muscles play a crucial role in palm supination, finger flexion, and thumb opposition.

    Palmar Cutaneous Branch

    The palmar cutaneous branch innervates the skin overlying the first dorsal interosseous muscle in the hand. This branch can be utilized during surgery to perform a digital block, which helps manage pain in the hand.

    Proper Palmar Digital Branch

    This branch innervates the lateral half of the skin of the index finger, middle finger, ring finger, and ulnar side of the little finger. It also supplies sensation to the skin on both sides of the fourth web space.

    Common Palmar Digital Branch

    The common palmar digital branch innervates the radial side of the little finger.

    Median Nerve Innervation in the Hand

    In the hand, the median nerve gives rise to various branches that innervate specific structures in the hand. These branches include:

    • Proper Palmar Digital Branch: Innervates the lateral half of the skin of the index finger, middle finger, and part of the ring finger.
    • Common Palmar Digital Branch: Supplies the radial half of the skin of the little finger.
    • Deep Branch of the Ulnar Nerve: Sensory component of the deep branch of the ulnar nerve.

    The median nerve's primary role in the hand is to control the functions of the thenar muscles and the flexor muscles of the hand.

    Subtopic Focus

    Carpal Canal Contents

    The carpal tunnel contains the median nerve, tendons of nine flexor muscles, and blood vessels. These structures are compressed in cases of carpal tunnel syndrome, leading to potential damage.

    Carpal Tunnel Syndrome

    Carpal tunnel syndrome occurs when there is excessive pressure within the carpal tunnel, causing compression of the median nerve and its associated tendons. Symptoms may include numbness, tingling, pain, and weakness in the fingers, particularly the thumb, index finger, middle finger, and half of the ring finger.

    Thenar Muscles

    The thenar muscles are important for gripping objects due to their involvement in closing the hand around an object. These muscles receive innervation from the motor branch of the median nerve and play a crucial role in various aspects of hand function.

    Flexor Muscles of the Hand

    The flexor muscles of the hand work together to produce flexion movements in the digits, allowing for grasping and manipulation of objects. They are primarily innervated by the median nerve, with the exception of the flexor digitorum profundus, which is innervated by the anterior interosseous branch.

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