Upper Limb Anatomy Clinical stuff Flashcards
(18 cards)
Erb’s Palsy
Damage to C5-6
Increased angle between neck and shoulder
Leads to weakened shoulder abduction and flexion, arm hanging by side of body, medial rotation of the arm, pronated forearm and flexed wrist
Presents as Waiter’s Tip
Klumpke’s Palsy
Damage to C8-T1 (a component of the ulnar, radial and median nerves)
Caused by excessive abduction of arm, or pancoast tumour
Weakened intrinsic hand muscles, loss of medial arm sensation
Presents as a claw hand
Memory: Klumpke has a “L” in it = Lower root dage
Musculocutaneous nerve damage
Loss of sensation in arm and lateral forearm
Loss of movement: elbow flexion
Axillary nerve damage
Loss of sensation to the shoulder region - “regimental patch”
Loss of movement: abduction from 15-90°
Injury to the surgical neck of the humerus
Median nerve damage
Loss of sensation to the lateral 3.5 fingers (thumb side)
Loss of movement: wrist flexion, lateral finger metacarpophalangeal flexion and interphalangeal extension (lumbricals) and thenar eminence muscles
Memory tools
TH(enar) = TH(umb)
The median nerve innervates the LOAF muscles in the hand:
Lateral lumbricals
Opponens pollicis
Abductor pollicis
Flexor pollicis
Carpal Tunnel syndrome
Tendonitis of the flexor retinaculum, lunate dislocation (FOOSH)
Affects thenar eminence: numbness, tingling/sensory loss, atrophy of the thenar eminence
Is a median nerve damage problem. Is a proxmal lesion
Distal lesion to the median nerve
Presents with hand of benediction, patient can’t make a fist if you ask them to. The lateral lumbricals and thumb stay extended
May be caused by supracondylar fracture of the humerus
Radial nerve damage
Loss of sensation to the posterior arm and forearm, below the fingertips of the medial 3.5 fingers on the back of the hand (dorsal)
Loss of motor: elbow and wrist extension
Injury to the body of the humerus (as this runs in the radial groove)
Damage leads to wrist drop (inability to extend wrist and fingers)
Can be caused by Saturday night palsy
Compression of nerve in the axilla
Present with wrist drop (loss of the extensors for the wrist)
Ulnar nerve damage
Loss of sensation to medial 1.5 fingers and medial forearm
Loss of motor: wrist flexion (the medial side), hypothenar eminence, medial finger metacarpophalangeal flexion and interphalangeal extension (lumbricals) and finger abduction and adduction (interossei)
Proximal damage leads to ulnar claw hand (e.g medial epicondyle fracture)
Patient can’t make a open their hand fully if you ask them to. The medial digits (4th and 5th fingers) cannot be extended. Differs from hand of benediction in that the patient can flex their thumb
Distal damage (e.g hook of hamate fracture/Guyton compression)
Clawing with no change in ability of fingers to flex
The innervation from the different branches of the BP
below
Clavicle fractures
Most commonly at the lateral third of the clavicle
May impact subclavian artery/vein
May be caused by a FOOSH
Scapular fractures
Rare, may be caused by high energy trauma
May affect suprascapular nerve (needed for abduction and external rotation)
Humerus fractures
Surgical:
Axillary nerve
Circumflex artery
Mid shaft:
Radial nerve
Deep brachial artery
Fractures of the Ulnar and radius
- Colles
- monteggia
- Galeazzi
- Smiths
Colles fracture (Also known as a dinner fork deformity)
- May result from falling with the wrist in extension (FOOSH)
- Fracture of radius distally, with distal radial fragment moving dorsally
Monteggia fracture
- Fracture of the ulnar bone with dislocation of the radial head (the fractured ulnar bone is what pushes the radial head out)
Galeazzi fracture
- Fracture of distal part of the radius with dislocation of distal radio-ulnar joint
- Ulna remains intact
Smith’s fracture
- May result from falling with the wrist in flexion
- Fracture of the distal radius, with distal radial fragment, with the fragment orientated in different directions
Fractures of the hand
Scaphoid fracture
- Most frequently fractured carpal bone, FOOSH
- Risk of avascular necrosis as the scaphoid is supplied distally to proximally
Hamate fracture
- Ulnar nerve close to hook of hamate, damage to nerve may lead to decreased grip strength
Metacarpal and phalangeal fracture
- Metacarpals closely bounded and tend to be stable
- DIstal phalanx injuries painful, have close relation to the flexor tendons
Inflammation clinical issues
- Tennis elbow
- Golfers elbow
- students elbow
Tennis elbow [lateral epicondylitis]
- Overuse injury to lateral epicondyle of the humerus, repetitive forearm and elbow activities
- Inflammation of the extensor carpi radialis brevis tendon
- Symptoms:
- Dull pain and tenderness at outer elbow
- Weak wrist extension, as wrist extensors attach to the lateral epicondyle
Golfer’s elbow [medial epicondylitis]
- Pain where the flexor tendons of forearm connect to medial epicondyle at the elbow
- S_ymptoms:_
- Tenderness at the inner elbow
- Weak wrist flexion, as wrist flexors attach to the medial epicondyle
Student’s elbow [bursitis]
- Swelling of bursa supporting the olecranon
- Most commonly caused by repeated pressure over time
Thoracic outlet syndrome
Winging of the scapula
Rotator cuff injuries
Thoracic outlet syndrome
- Thoracic outlet: the space between the collarbone and first rib
- Compression of the vasculature and nerves in the thoracic outlet, leading to shoulder and neck pain, finger numbness
Winging of the scapula
- Paralysis of the serratus anterior as a result of injury to the long thoracic nerve
- Prominent when person leans on hand or presses it against a wall
Rotator cuff injuries
- Instability of the glenohumeral joint, supraspinatus most commonly ruptured
