DDX
A 3-year-old child is brought in by his mother after he stopped using his right arm following a moment where the child was lifted by the wrist. He keeps the arm slightly flexed and pronated, refusing to move it. There is no swelling, bruising, or deformity. What is the most likely diagnosis?
Nursemaids Elbow
Name the four nerve damage signs and what nerves they correlate with.
Waiters Tip; Axillary
Claw Hand; Ulnar
Benedict Sign; Median
Wrist Drop; Radial
What ligaments are found within the AC Joint?
Acromioclavicular Lig. and Coracoclavicular Lig.
What structure is found where the Subclavian Artery becomes the Axillary Artery?
What does the Suboccipital Nerve innervate?
All four suboccipital muscles
A 72-year-old woman trips and falls on her outstretched hand. She presents with wrist swelling and a classic “dinner fork” deformity. X-rays confirm a Colles fracture.
Exam Findings:
- Severe pain despite immobilization
- Persistent numbness in the thumb and index finger
What is the secondary injury present in this patient?
Carpal Tunnel Syndrome
Which nerve innervates the deltoid and teres minor, and what movements are impaired if it is damaged?
Axillary Nerve: Lateral Rotation, Shoulder Abduction
What are the attachment points of the pectoral fascia?
Sternum and clavicle
What vein bifurcates to become the Basilic and Cephalic Veins?
Median Cubital Vein
Which of the back muscles work primarily for proprioception?
Serratus Posterior Superior/Inferior, Multifidus, Rotatores, Semispinalis
A 35-year-old weightlifter complains of chronic shoulder pain with overhead lifting. The pain worsens with internal rotation and abduction. What is the most likely diagnosis?
Impingement/AC Joint Damage
A construction worker presents with difficulty grasping objects and numbness in the medial forearm and hand. Which brachial plexus branch is likely affected?
Ulnar Nerve
What muscles are found within the clavipectoral fascia?
Subclavius and Pectoralis Minor
The Superior Vena Cava gives rise to what vein that supplies the Subclavian?
What is the most likely mechanism of injury for a P.L.L (posterior longitudinal ligament) sprain?
Hyperflexion
A 25-year-old amateur boxer presents with difficulty raising his arm above shoulder level. He denies direct trauma but reports being repeatedly punched in the ribs during sparring. What is the most likely diagnosis?
Long Thoracic Nerve damage
A motorcyclist presents after a crash with loss of shoulder abduction, external rotation, and elbow flexion. Sensation is reduced over the lateral arm. Which parts of the brachial plexus is affected?
Axillary Nerve and Musculocutaneous Nerve
The brachial fascia is a continuation of what two fascias?
Deltoid and Axillary
Name the most proximal branch of the Axillary Artery and the structure that separates it from the rest?
Superior Tx Artery and Pec Minor
This layer, found in blood vessels, governs blood flow throughout the body
Tunica Media
A 40-year-old construction worker falls off scaffolding, landing on his right shoulder. He complains of clavicle pain and difficulty lifting his arm. Initial X-rays show a midshaft clavicle fracture. The patient is sent home with a sling, but three weeks later, he reports worsening pain and numbness in his hand.
Exam Findings:
- Tingling and weakness in the ulnar nerve distribution
- Diminished grip strength
- Palpable subclavian pulse but decreased sensation in the medial forearm
What is the final diagnosis of this patient?
Clavicle fracture and Ulnar nerve damage
Name all muscles innervated by the Ulnar Nerve.
Flexor Carpi Ulnaris, 1/2 Flexor Digitorum Profundus, Lumbricals, Opponens Digiti Minimi, Abductor Digiti Minimi, Flexor Digit Minimi Brevis, Dorsal/Palmar Interrosei
What is found within and what are the borders of the ASB (snuff box)? both directional terms and anatomical structures are required
Medial (ulnar) border: The tendon of the extensor pollicis longus
Lateral (radial) border: The tendons of the extensor pollicis brevis and the abductor pollicis longus
Proximal border: The styloid process of the radius
Distal border: Base of first metacarpal
Contents: radial artery, scaphoid and trapezium bones
Trace the pathway of a blood droplet from the aortic arch to the wrist and back to the heart, naming all the arteries and veins it traverses along the way. Be specific about the anatomical landmarks and structures.
Aortic Arch --> Brachiocephalic Artery --> Subclavian Artery --> First Rib --> Pec Minor --> Axillary Artery --> Teres Major --> Brachial Artery --> Radial and Ulnar Arteries --> Radial and Ulnar Veins --> Basilic and Cephalic Veins --> Brachial and Axillary Veins --> Subclavian Vein ---> Brachiocephalic Vein --> Superior Vena Cava
Where are cell bodies of parasympathetic neurons found?
Terminal Ganglia