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Flashcards in Clinical Correlations Deck (36):

Musculotaneous Nerve Damage

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.


Path of axillary nerve

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


Two common situations that affect the axillary nerve

Shoulder dislocation, Surgical neck fracture of the humerus


Evaluating axillary nerve

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


Path of radial nerve

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


Crutch palsy

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


Saturday night palsy

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)


Wrist drop

Wrist and elbow joints can only maintain flexion


Median Nerve path

Anterior aspect of the arm and forearm


Proximal median nerve lesion

All of the muscles/skin that are innervated are compromised


What nerve can a supracondylar fracture compromise?

Median nerve, very common in children


Pronator Teres Syndrome

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


Distal median nerve lesion

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


Carpel tunnel syndrome

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


Ape hand

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


Ulnar Nerve path

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


Proximal Ulnar injury causes

Medial epicondyle injury. Prolonged pressure to medial aspect of elbow


Distal Ulnar Injury Causes

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


Ulnar Lesion presentation (general)

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


Ulnar Claw

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


Ulnar Paradox

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"


End Duchenne's Pathology

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


Klumpky's Palsy

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.


Dupuytren's Contracture

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


Scapular winging

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


Medial scapular winging

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


Lateral scapular winging divisions

Trapezius and Rhomboid


Trapezius Lateral Scapular winging

Damage to the Accessory nerve from blunt trauma/surgery


Rhomboid Lateral Scapular Winging

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


Thoracic Outlet Syndrome Catagories

Neurogenic, Venous, Arterial


Neurogenic TOS

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


Symptoms of TOS

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


Pancoast Tumor

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


TOS in weightlifters

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


Venous TOS

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.


Arterial TOS

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.