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Anatomy Review PDF
Anatomy Review PDF
U world
Supplement to First Aid
MSS
Upper Extremity
Rotator cuff injury
• Rotator cuff: (SITS)
– Supraspinatus,
– Infraspinatus,
– Teres Minor and
– Subscapularis
• Most commonly injured: Supraspinatus
tendon
• Presentation: Pain on Abduction of arm
Impingement Test: Supraspinatus
Jobe’s Test or Empty can test
GH joint is the most common dislocated joint in body
Anterior
dislocations are
more common
than posterior
Winged scapula
• 90°-180° Abduction
• Serratus
Anterior
Radial n. Injury Posterior Arm
“Wrist Drop” From
- Mid-shaft humerus Axillary n.
fractures
- “Crutch” palsy
- Supplies extensors
muscles (posterior) and
sensory to posterior
arm Radial n.
- Wrist drop b/c can’t
extend
Radial n. course
Ulnar n.
Passes by Medial epicondyle in
arm (most common injury site)
and the guoyon’s canal over
Hook of hamate (another site of
injury)
Guoyon’s canal
Nerve passing by
hook of hamate
Median
n.
C6-T1 Antecubital
fossa
Median n. supply to muscles in hand
See loss of
Thenar
eminence w/
median n.
damage
“ape hand”
deformity
Median n. injury • Injury
– Suicide attempts
– Carpal tunnel syndrome
• Tx: release flexor retinaculum
• Denervation atrophy
– Loss of thenar eminence so “ape
hand” deformity
– Benedict/Bishop/pope hand when
asked to make fist
• Loss of sensation
– Palmar surface
– 1st three and ½ fingers
Procedures and Nerve Injuries
• Radical Mastectomy – Long thoracic n.
• Thyroidectomy- Recurrent Laryngeal n.
– Recurrent laryngeal during ligation Inferior thyroid a.
– External branch of superior laryngeal nerve during ligation of superior thyroid a.
• Delivery of child- (Shoulder Dystocia)
– Musculocutaneous and Suprascapular n.
– “Head and shoulder violently stretched apart”
– Erb-Duchenne palsy (Waiter’s Tip)
– Shoulder adducted, arm pronated, elbow extended
MSS
Lower Extremity
Common Peroneal (Fibular) n.
(FOOT DROP)
Prone to injury b/c
superficial location
especially lateral blow
to leg or during leg
cast
Common peroneal
superficial peroneal
and deep peroneal n.
Deep peroneal
innervates anterior
compartment which
dorsiflexes foot
Superficial peroneal
innervates lateral
compartment
(everts foot)
Sensory Innervation: Peroneal n.
Posterior
Leg
Tibial n –
Posterior
thigh
(plantarflex
and invert).
Sensory to
sole of foot
Femoral n. injury
• Can be due to big retroperitoneal hematoma, trauma, stretch injury,
etc
• Innervates quadriceps muscles so:
– Presentation: difficulty w/ climbing stairs and “knee buckling”
• Sensory loss:
– Anterior and medial thigh
– Medial leg (saphneous n.)
• Saphneous nerve is the largest purely sensory branch of femoral n.
• Patellar reflex diminished
Superior Gluteal n. Injury
• Gluteus medius and minimus muscles weaken
• Result: Waddling gait
• Cause: Supero-medial buttock injections
• Positive Trendelenburg’s sign
– Injury is:
• C/L side of dropped hip/pelvis
• I/L side of standing leg
– Pic: We see Right sided n. injury
Superior Gluteal n. injury
Superolateral
quadrant-
safest place
for buttock
injections
Superomedial
injection can injure
superior gluteal n.
Note: Lachman’s
test for ACL tear
is MORE sensitive
PCL tear- Posterior Drawer test
Knee flexed
90° and
place
posterior
traction the
tibia
PCL tear
Terrible ‘Unhappy’ Triad
• Anserine bursitis
• Overuse in athletes
• Chronic trauma in OBESE pts
• Pain at medial aspect of
knee
Psoas Muscle
Located Paravertebral B/L
Common Deformities
Presentation Nerve Injured
Brief
Jugular Foramen (Vernet)
Syndrome
Trachea
Azygous v.
Esophagus
Abdominal CT
A- 2nd part of
duodenum (lies by
the head of
pancreas)
B- Pancreas
E- jejunum loops
• Duodenal ulcers are more common than gastric ulcers. Found in the
bulb.
– Anterior bulb: Perforate
– Posterior bulb: Hemorrhage through gastroduodenal a. ( common
hepatic a. )
Most gastric ulcers lesser curvature hemorrhage L. gastric a. ( from
celiac trunk)
Duodenum
1st part
- NOT
Retroperitoneal
2nd part
(Celiac a.)
SMA and
plexus
- Usually occurs
secondary to
rapid weight loss
(lose mesenteric
fat pad) or spinal,
scoliosis surgery
Lesser Omentum
- Inferior mesenteric a.
prevents it from ascending.
• Hysterectomy:
• Ureter lies
underneath
uterine a.
• Ovarectomy
• Ureter and
ovarian
vessels cross
pelvic inlet so
both at risk
11/12TH Rib Fracture- Kidney injury
- Iliac fossa
Transplanted kidney - Attach donor renal a
recipient ext/internal iliac
a.
- Transplant ureter or attach to
old ureters (recipient’s ureter)
Lymph node drainage
• Para-aortic nodes: Testes b/c follows embryological origin
(retroperitoneal)
– Also blood supply to testes is from aorta
• Superficial Inguinal- All cutaneous drainage below umbilicus,
including external genitalia (scrotum and labia) and anus up to
pectinate line
• Deep inguinal- glans penis and clitoris drain directly. Afferent
from superficial inguinal nodes
• External iliac- drain superficial and deep inguinal nodes
Patent
Process
Vaginalis
(Communicating
hydrocele )
Varicocele
• Left testes more
common
• b/c Left testicular v.
drains Renal v.
IVC
• L renal vein travels
b/w aorta and SMA
so can be
compressed easily
especially if SMA
engorges
• Anterior urethra- Damaged during saddle injuries (fence or falling off bike
injuries) – urine leaks beneath deep fascia of Buck
• Posterior urethra- Membranous portion is the weakest part and is prone to
injury during pelvic fractures (MVA). Urine leak into retropubic space
• Urethral injury-
• S&S: full bladder sensation, inability to void, high riding boggy
prostate, blood at urethral meatus
• Foley is C/I
Pudendal nerve
block • Intravaginal pudendal block
in OB (palpate ischial spine)
• Nerve runs behind • Done when its too late for
ischial spine and epidural anesthesia
sacrospinous ligament