Lecture 17 Flashcards
(12 cards)
Physical examination show that his shoulder was
internally rotated and adducted, and his elbow was
extended.
Shoulder is adducted and internally rotated = suprascapular and axillary nerves (C5,C6)
Elbow is extended = musculocutaneous (C5,C6,C7)
injury to upper brachial plexus (roots/trunks)
sensory loss along (C5,C6,C7) dermatomes (lateral border of limb)
Erb’s palsy is most common presentation
Damage to the lower brachial plexus (C8/T1)?
Klumpke’s palsy
Loss of flexor carpi ulnaris (FCU) and medial ½ of flexor digitorum profundus (FDP)
Loss of all intrinsic hand muscles (both ulnar and median)
Sensory loss along medial border of hand and forearm and arm (C8 and T1 dermatomes)
Midshaft of humerus fracture?
The radial nerve is most likely affected
Common radial nerve injury’s?
- Injury in axilla
loss of ability to extend elbow
wrist drop
impaired grip strength
sensory loss: Arm – posterior and lower lateral Forearm – posterior Hand – dorsum of hand-lateral 2 ½ digits (proximal part of these digits)
- injury in the arm
has the ability to extend elbow (already innervated)
wrist drop
impaired grip strength
sensory loss:
Arm - variable
Forearm – posterior
Hand – dorsum of hand- lateral 2 ½ digits (proximal part of these digits)
- injury in the forearm
He is unable to extend the left wrist and MCP joints and has difficulty in extending the IP joints of digits 2-5. He can extend the elbow. Sensation is lost in the lateral half of the dorsum of the left hand. Which of the following nerves has most likely been injured to result in these signs, and in what part of the upper limb is the injury located?
Radial nerve
mid humeral injury
Physical examination shows decreased sensation on the thenar eminence and the lateral 3 and ½ digits. Sensation is preserved in the mid palm.
Median nerve in the carpal tunnel is most likely injured
Common median nerve injuries?
1. At or above the elbow weakened wrist flexion thenar wasting ulnar deviation loss of flexion of index and middle fingers at DIP and PIP joints loss of pronation loss of opposition loss of flexion of the thumb weakened abduction of the thumb
sensory loss:
Palmar aspects of thumb, index, middle, and half of ring finger up to the DIP on the dorsal aspect
benediction hand when patient tries to make a fist
- injury at the anterior intersseous nerve
3. at the level of the wrist LLOAF muscles of intrinsic hand are paralyzed Atrophy of thenar muscles: Loss of opposition of thumb Weakened abduction and flexion of thumb
- injury at the palm
OAF muscles of intrinsic hand are paralyzed
Atrophy of thenar muscles, loss of opposition, weakened flexion and abduction of thumb
No sensory loss
Carpal tunnel syndrome
compresses the median nerve
Sensory deficits:
Paresthesia in the median nerve distribution in the hand (except central palm which is supplied by the palmar cutaneous branch), nocturnal pain common
Motor deficits:
Loss of function to muscles supplied by median nerve in the hand
Tinel sign and phalen maneuver
Fracture of the hook of the hamate?
Ulnar nerve, vein, and artery are at risk
Common ulnar nerve injuries?
- at or above the elbow
Paralysis of FCU; hand deviates radially
Paralysis of ulnar ½ FDP; lose flexion of ring & little
fingers at DIP (FDS still intact for flexion at PIP)
Sensory loss:
Medial palmar 1 ½ & dorsal 2 ½ digits
- at the wrist
Paralysis of hypothenar muscles
Paralysis of 3rd and 4th lumbricals: decreased flexion of at MCP and decreased extension at IP joints of ring and little finger Paralysis of all interosseous muscles (metacarpal guttering)
Loss of adduction of thumb
Sensory loss:
Palmar part of little & 1/2 of ring fingers
Froment’s test?
Patient can’t “hold on” to the paper with
adductor muscle, but FPL and FPB are intact
(median) which allows for “holding on” by FLEXING the
interphalangeal joint of the thumb
ulnar nerve damage
Fracture of the surgical neck of the humerus?
Axillary nerve and posterior humeral circumflex artery
could be damaged
Decreased lateral rotation
Decreased abduction
Loss of sensation to the lateral shoulder
