Clinical Correlations

Question 1

Musculotaneous Nerve Damage

Answer 1

Rare to have isolated damage, but can happen if coracobrachialis grows too large. Lesions to the nerve create inability to flex elbow and paresthesia in lateral forearm.

Question 2

Path of axillary nerve

Answer 2

Off of posterior cord, thru quadranglar space, branches to deltoid and teres minor

Question 3

Two common situations that affect the axillary nerve

Answer 3

Shoulder dislocation, Surgical neck fracture of the humerus

Question 4

Evaluating axillary nerve

Answer 4

Shoulder abduction: cannot laterally raise arm due to axillary nerve damage

Question 5

Path of radial nerve

Answer 5

Posterior cord, thru triangular interval, runs posterior to the lateral epicondyle, innervates tricep and extensors

Question 6

Crutch palsy

Answer 6

Continuous pressure on the posterior aspect of axilla causing weakness/paresthesia of posterior arm and forearm (radial nerve wrist drop)

Question 7

Saturday night palsy

Answer 7

Pressure on the posterior aspect of axilla from passing out with a chair under the arm. Causes weakness/paresthesia of posterior arm and forearm (radial nerve wrist drop)

Question 8

Wrist drop

Answer 8

Wrist and elbow joints can only maintain flexion

Question 9

Median Nerve path

Answer 9

Anterior aspect of the arm and forearm

Question 10

Proximal median nerve lesion

Answer 10

All of the muscles/skin that are innervated are compromised

Question 11

What nerve can a supracondylar fracture compromise?

Answer 11

Median nerve, very common in children

Question 12

Pronator Teres Syndrome

Answer 12

Excessive use of the pronator teres (rotation) causes the median nerve to be continually squeezed/compromised

Question 13

Distal median nerve lesion

Answer 13

Will affect the hand musculature of the median nerve and some cutaneous distributions, but forearm musculature is unaffected

Question 14

Carpel tunnel syndrome

Answer 14

Most common distal median nerve lesion. Flexor retinaculum becomes inflamed, pushing on a tendon, decreasing space, thus pushing on the median nerve. Results in paresthesia of 1st 3 digits and thenar eminence atrophy. Pt has inability to use thumb in opposition

Question 15

Ape hand

Answer 15

Hand that is in MP joint extension and IP joint flexion at rest. When asked to make a fist, pt displays pope hand

Question 16

Ulnar Nerve path

Answer 16

Posterior cord, crosses posteriorly at elbow via the cubital tunnel, passes thru Guyon’s canal to hand

Question 17

Proximal Ulnar injury causes

Answer 17

Medial epicondyle injury. Prolonged pressure to medial aspect of elbow

Question 18

Distal Ulnar Injury Causes

Answer 18

Cyclist/weightlifter pressure on Guyon’s canal. Happens more in low BF pts due to lack of fat pads

Question 19

Ulnar Lesion presentation (general)

Answer 19

Lack of cutaneous sensation in pinky, medial half of ring finger. Weakness in finger ab/adduction (paper between digits 3&4 test)

Question 20

Ulnar Claw

Answer 20

Hand is in pope’s blessing hand AT REST. MP/IP joints naturally flex

Question 21

Ulnar Paradox

Answer 21

More proximal lesions seem “better” in presentation due to flexor digitorm profundus innervation not flexing the fingers. Lessens the appearance of the claw. “Closer to the paw, the worse the claw”

Question 22

End Duchenne’s Pathology

Answer 22

When C5-C6 have been compromised due to neck damage (newborns injured during birth, lateral flexion injury). Compromised MAR nerves. “Waiter’s tip palsy”-Adducted arm, internally rotated, wrist flexed

Question 23

Klumpky’s Palsy

Answer 23

C8-T1 stretched/torn. Upper limb is usually pulled to injury nerves. Compromise to ulnar and some median nerve lost. Digits 2-5 flexed and some wrist flexion.

Question 24

Dupuytren’s Contracture

Answer 24

Nodules are formed at the base of the MP joint from the palmar aponeuroses. Most often affects ring finger. MP joint cannot fully extend. DO NOT massage or stretch bc it will make it worse

Question 25

Scapular winging

Answer 25

Scapula protrudes in a non-anatomical manor. Can be further categorized into medial and lateral

Question 26

Medial scapular winging

Answer 26

Most common. Scapula is displaced medially and posteriorly (more retracted). Typically loss of serratus anterior Long thoracic innervation. Causes: mastectomy damage (iatrogenic) or direct blows to area causing a lesion to the long thoracic nerve

Question 27

Lateral scapular winging divisions

Answer 27

Trapezius and Rhomboid

Question 28

Trapezius Lateral Scapular winging

Answer 28

Damage to the Accessory nerve from blunt trauma/surgery

Question 29

Rhomboid Lateral Scapular Winging

Answer 29

Rarest form. Damage to dorsal scapular nerve. Inferior angle is displaced laterally, so scapula goes into upward rotation

Question 30

Thoracic Outlet Syndrome Catagories

Answer 30

Neurogenic, Venous, Arterial

Question 31

Neurogenic TOS

Answer 31

Most common type of TOS. When anything interferes with the brachial plexus. Cervical ribs, Pancoast tumors, and weightlifters can be causes of symptoms

Question 32

Symptoms of TOS

Answer 32

Any signs of upper limb nerve hinderance, can be any or all of brachial plexus

Question 33

Pancoast Tumor

Answer 33

Cell cancer that grows on the apex of the lung that can grow into the cervical region.

Question 34

TOS in weightlifters

Answer 34

Can have hypertrophy in scalenes, causing a decrease in space for the brachial plexus. Stretching and education on training helps

Question 35

Venous TOS

Answer 35

Second most common. Subclavian vein becomes compressed between 1st rib and clavicle. Can cause a clot. Clot then causes swelling, edema, and pain in the upper limb.

Question 36

Arterial TOS

Answer 36

Least common type of TOS. Most often happens as the subclavian artery emerges between the scalene musculature. Pt presents w/ painful, tingling, numb or cool arm. Most restore blood flow to avoid necrosis.