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
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 Syndrome What 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
Shoulder Osseous 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.
FOOSH Osseous 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 Sites Vascular- 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”, 1 st dorsal digital space
Avascular Necrosis of Scaphoid Bone Vascular- Arteries
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.