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Flashcards in neuro pathologies UE Deck (29):
0

Injury to the superior roots of brachial plexus

Erb-Duchenne palsy (C5-C6)
Waiter's tip postion

1

Traction injury of lower brachial plexus

Klumpke's paralysis
Claw hand - thumb on the same plane as palm, whole hand, both median and ulnar (C8-T1)

2

Radial nerve leisions

Clavicle, axillary, radial groove, supinator
Posterior motor brach "Posterior interosseus nerve": it enters supinator and travels down the lateral Radius to the wrist
Superficial branch: travels down the posterior forearm to the hand

3

Radial nerve lesions causes

Fractures at spiral radial groove
-dislocations of head of radius, humeroradial or radioulnar joint
- Post surgical complications
-compression

4

Radial nerve related pathologies

Crutch palsy at axilla
Saturday night palsy at spiral groove of humerus from direct pressure against a firm object
Posterior interosseuous syndrome: comes off in front of the lateral epicondyle of humerus
compression in arcade/canal of Frohse, motor nerve, get wrist drop
Cheiralgia parasthetica: compression of superficial branch of radial nerve as it passes under tendon of brachioradialis

5

If injury is proximal to elbow....

both sensory and motor affected,

6

if injury is distal to elbow...

Only sensory or motor is affected

7

what causes cheiralgia paresthetica

Cast, hand cuffed compression swelling

8

Median Nerve lesions

Path Under pronator teres, under carpal tunnel and end between 2nd and third fingers

9

Median nerve lesions causes

Fractures at elbow, wrist and carpals
Dislocations at elbow, wrist, carpals
Compressions
Trauma

10

Symptoms of Median nerve lesions

Ape hand - thumb in same plane as rest of hand since there is no opposition (wasting of thenar eminence)
-oath hand - you see when you make a fist only digit 4 & 5 can be flexed
- can't grasp objects (keep dropping things)
-can't pronate forearm, flex PIPs, flex DIPs of digit #2, 3
-Weak wrist flexion weak thumb movements
-altered sensation on digit 1, 2, 3, and half of 4

11

Median legion pathologies

Ligament of struthers
Pronator Teres Syndrome
Anterior interosseus syndrome
Carpal tunnel syndrome

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Where is ligament of struthers

Runs from an abnormal supr on shaft of humerus to medial epicondyle. Median nerve can be pinched/compressed above elbow as it passes under - only 1% of populaton

13

What is pronator teres syndrome

Compressed at proximal attachment of pronator teres
Aching in forearm
numbness in thumb and index - some weakness in thenar mm

14

What is anterior interosseous syndrome

Branch of median nerve
Motor nerve - motor loss of FPL, lat 11/2 of FDP, pronator quadratus
Paralysis of flexors in index finger and thumb at tip, so reverse froment's sign, can't touch them together at tip, touch at distal knacles.
Can be entrapped it passes between 2 heads of pronator teres.

15

What is carpal tunnel syndrom

Most common entrapment condition in the arm
compression through carpal tunnel at wrist
Numbness and tingling in digit #1,2,3 and half of 4
Distinguishing feature = presence of nocturnal symptoms that wake person up
Muscle weakness and clumsiness of thumb and fingers
later get thenar muscle wasting

16

How the compression of median nerve in carpal tunnel occurs?

size of the tunnel decrease
Size of the contents passing through increases

17

Carpal tunnel structures and tendons

Flexor retinaculum forms roof
Fexor retinaculum attaches to scaphoid tubercle and trapezium
Carpal bones form floor
Median nerve, Flextor digitorum superficialis, profundus and flexor pollicis longus (9 tendons and 1 nerve)

18

Ulnar nerve leisons

path

19

Ulnar nerve lesions causes

fractures at medial epicondyle, mid-forearm, wrist dislocations of elbow
Post surgical complications (badly positioned arm while under anesthetics)
Compression -resting elbow on hard surface
- wearing tight wrist band
-cycling
-repetitive actions, trauma

20

Ulnar nerve lesions symptoms

Ulnar claw hand - baby finger hyper extended and abducted at MCP and flexed at iP
-ring finger is hyper extended at MCP and flexed at IP (loss of lumbricals)
-atropy of interosseous mm
-muscle wasting of hypothenar
-Altered sensation in little finger and medial half of ring ringer (palmar and dorsal)
-Froment's sign is positive

21

Froment's sign

Hold paper between thum and index finger
can't do it without using adductor pollicis
a patient flex thumb to use flex pollicis longus

22

tardy ulnar palsy

ulnar palsy is common complication of fractures of elbow
-a late tardy ulnar palsy can occur years after a fracture
-it's associated with callus formation or a valgus deformity of the elbow
-these produce a gradual stretching of nerve in ulnar groove of medial epicondyle

23

Thoracic outlet syndrome

Compression of brachal plexus from structures in the thracic outlet (from interscalene triangle to inferior border of axilla)
-subclavian aa and vv may also be compressed

24

Thoracic outlet syndrome path

Brachial plexus travels with the subclavian aa between anterior and medial scalene
subclavian vv joins and neurovascular bundle goes below clavicle and under pec minor insertion and down arm

25

TOS causes

poor posture
c spine /clavicle dislocation
cervical rib
pec minor
scalens
whiplash
systemic disease - RA, DM, hyothyroid
pregnancy

26

TOS symptoms

Pain, numbness, weakness, tingling in arm or across upper thoracic area or over scapula
Trophic changes in tissue with blood vessel compression

27

TOS locations (5)

1 Presence of cervical rib - additional rib at C7
2 Anterior scalene syndrome - compression btw ant & middle scalene
3 Interscalene triangle - ant, middle scalanes, rib 1, brachial plexus and subclavian artery pass through only (subclavian vein is anterior)
4 Costoclavicular syndrome- compression btw coracoid process and pec minor
5 Pectoralis minor syndrome

28

Travell's test and Addison's test

Travell's test (middle scalene) Extend, rotate arm, turn head away from the arm - check radial pulse

Addision's test (anterior scalene) Extend, rotate arm, turn head toward the arm - check radial pulse