Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal System > Clinical Cases Of The Upper Limb > Flashcards

Clinical Cases Of The Upper Limb Flashcards

1
Q

Discuss damage to the upper brachial plexus

A

Occurs at C5, C6 (C7)

Damage to upper parts of brachial plexus (roots &/or trunks)

Most common presentation- Erb’s palsy

Arm adducted and internally rotated, forearm extended and pronated

Sensory loss along lateral border of limb (C5,C6, +/-C7) dermatomes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the clinically involved nerves in the upper brachial plexus (damage)?

A

Suprascapular: inability to initiate abduction and loss of external rotation

Axillary: loss of abduction to 90 degrees and external rotation

Musculocutaneous- loss of forearm flexion and weakened forearm supination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Discuss lower brachial plexus damage

A

C8/T1

Klumpke’s (Klempe-dejerne) palsy

  • damage to lower parts of brachial plexus (trunks or median cord)
  • loss of flexor carpi ulnaris (FCU) and medial 1/2 of flexor digitirum profundus (FDP)
  • Loss of all intrinsic hand muscles (both ulnar and median)
  • SENSORY LOSS ALONG MEDIAL BORDER OF HAND AND FOREARM AND ARM (C8 & T1 DERMATOMES)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the origin of the radial nerve?

A

From posterior cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the course of the radial nerve?

A
  • Spiral (radial) groove of humerus
  • Crisses elbow anterior to lateral to lateral epicondyle

Ends by splitting into superficial (Sensory only) and deep (motor only) just distal to the elbow

  • deep pierces the supinator and exits becoming the posterior interroseus nerve
  • Superficial comes off in the forearm but is carrying sensation from the hand
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the motor supply of the radial nerve?

A

Supplies extensors of the forearm, wrist and digits (via the radial nerve, deep nerve and posterior interosseous nerve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the Sensory supply of the radial nerve ?

A

Arm- posterior and. Lower lateral

Forearm-posterior

Hand-dorsum of hand/ lateral 2 1/2 digits (proximal part of these digits)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 3 common radial nerve injuries?

A
  1. Injury in the Axilla (Saturday night palsy)
  2. Injury in the arm eg midshaft fracture of the humerus
  3. Injury in the forearm eg posterior interosseous nerve syndrome (motor only)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Explain depth injury in axilla

A

Radial nerve injury

  • loss of ability to extend the elbow joint
  • Wrist drop
  • Impaired grip strength

Sensory loss:

  • Arm: posterior and lower lateral
  • Forearm: posterior
  • Hand- dorsum of hand- lateral 2 1/2 digits (proximal part if these digits)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Explain injury at the midshaft of the humerus

A

Radial nerve injury

Retain ability to extend the elbow joint

Wrist drop

-Impaired grip strength

Sensory loss: 
-Arm- variable 
-Forearm- posterior
-Hand-dorsum of hand- lateral 2 1/2 digits
(Proximal part of these digits)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the origin of the m3dian nerve?

A

From lateral & medial cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the course of the median nerve?

A

Crosses anterior to elbow through cubital fossa

-supplies all muscles in superficial and intermediate flexor compartment of firearm except FCU

  • Just distal to elbow, gives off the anterior interroseus
    • Supplies the deep flexor compartment except ulnar half of FDP

Through carpal tunnel into the hand

  • motor innervation:
    - palmar digital branches-2 lumbricals (1st and 2nd)
    - recurrent branch -OAF muscles

Sensory innervation
-palmar digital branches-lateral 3 1/2 fingers palmar side and their distal phalanx on the dorsal side

-palmar cutaneous branch- mid-palm (comes off median in firearm and doesn’t pass through carpal tunnel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the common median nerve injuries?

A
  1. At/above the elbow eg supracondylar fracture
  2. Injury to the anterior interroseus nerve (AIN) only e.g. entrapment of the AIN between the two heads of pronator teres
  3. At the level of the wrist e.g. carpal tunnel syndrome, lunate dislocation, suicide attempt
  4. Injury to the palm e.g. laceration to the base of the thumb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the effects of median nerve injury at or above the elbow ?

A

Injury at or above elbow

Benediction hand

Weakened wrist flexion
-Thenar wasting: thenar eminence is flatted due to atrophy of thumb OAF muscles

  • Ulnar deviation (FCU unopposed)
  • Loss of flexion of index and middle fingers at DIP & PIP joints (FDP and FDS)
  • Loss of pronation
  • Loss of opposition of thumb
  • Loss of flexion of thumb
  • Weakened abduction of thumb

Sensiry: palmar aspects of thumb, index, middle, and half of ring finger up to the DIP on the dorsal aspect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Identify Sensory effects in median nerve injury at or above elbow

A

Palmar aspects of thumb, index, middle, and half of ring finger up to the DIP on the dorsal aspect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is benediction hand?

A

Injury at or above elbow

Benediction hand- when patient attempts to make a fist.

The index and middle fingers stay straight (both FDS and FDP to these digits is intact-Ulnar)

Thumb remains in plane of palm - flexor pollicis longus and brevis have lost innervation but adductor pollicis is intact- Ulnar

17
Q

What are the motor effects of median nerve injury at the wrist?

A
  • Flexor muscles in firearm are NOT paralyzed so no benediction hand
  • Wrist flexion, forearm pronation and long flexor of thumb all intact
  • LLOAF muscles of intrinsic hand are paralyzed:
    • Atrophy of thenar muscles:
      • Loss of opposition of thumb
      • Weakened abduction and flexion of thumb
18
Q

What are the sensory effects of median nerve injury at the wrist?

A

Same as previous

Palmar aspects of thumb, index, middle, and half of ring finger up to the DIP on the dorsal aspect

19
Q

What is Carole tunnel syndrome?

A

Entrapment syndrome causing increased pressure in the carpal tunnel

-Compresses the median nerve

20
Q

What are the sensory deficits of carpal tunnel syndrome?

A

Paresthesia in median nerve distribution in the hand (except central palm which is supplied by the palmar cutaneous branch), nocturnal pain common

21
Q

What is the motor deficit of carpal tunnel syndrome?

A

Loss of function to muscles supplied by median nerve in the hand

22
Q

How can we test medial nerve Sensory functions, fir example, fir carpel tunnel syndrome ?

A

Provocative tests for median nerve function in the hand

A) A positive Tinel sign refers to distally radiating pain and/or parasthesia elicited by precussing a superficial peripheral nerve, in this case the median.

B) the Phalen maneuver is performed by apposing the wrists in goo of flexion. Parasthesia in the hand within 60 seconds is considered a positive test

23
Q

Explain the effects of injury to median nerve in the proximal palm

A

Injury in proximal palm : laceration to the base of the thumb

  • recurrent branch
  • Motor only nerve
  • Flexor muscles in forearm are NOT paralyzed
  • OAF muscles of intrinsic hand are paralyzed
  • Atrophy of thenar muscles, loss of opposition, weakened flexion and abduction of thumb
  • No sensory loss
24
Q

What is the origin of the ulnar nerve?

A

From medial cord

25
Q

What is the course of the ulnar nerve?

A

Course:
-Crosses behind medial epicondyle

  • Descends forearm covered by flexor carpi ulnaris
  • At distal third of the forearm gives a dorsal cutaneous branch
  • Crosses the wrist superficial to flexor retinaculum at Guyon’s canal
  • Divides into superficial branch and deep branch
26
Q

Describe the motor innervation of the ulnar nerve

A

Deep motor branch to all the muscles of the hand except LLOAF

27
Q

Describe Sensory innervation of the ulnar nerve

A
  • Superficial cutaneous branch- sensory to the palmar medial 1 1/2 digits
  • Dorsal cutaneous branch: Sensiry to the dorsal medial 2 1/2 digits
28
Q

What are the common ulnar nerve injuries?

A
  1. At the wrist:
    - suicide attempt
    - fracture of hook of hamate
    - Entrapment in Guyon’s canal
  2. At the elbow:
    - Cubital tunnel syndrome (injury at the elbow)
    - medial epicondyle fracture
29
Q

Explain the effects of ulnar nerve injury at or above elbow

A

Paralysis of FCU; hand deviates radially

Paralysis of ulnar 1/2 FDP; lose flexion of ring & little fingers at DIPb(FDS still intact for flexion at PIP)

Sensiry loss:
-Medial palmar 1 1/2 & dorsal 2 1/2 digits

30
Q

What are the general effects of ulnar injury?

A
  • Paralysis of hypothenar muscles
  • Paralysis of 3rd and 4th lumbricals: decreased flexion at IP joints of ring and little finger
  • Paralysis of all interosseous muscles- ‘metacarpal guttering’
  • Loss of adduction of thumb
31
Q

What are the motor impairments of the ulnar nerve injury at the anterior wrist?

A

No paralysis of FCU or ulnar 1/2 of FDP

  • Paralysis of hypothenar muscles
  • Paralysis of 3rd and 4th lumbricals: decreased flexion of MCP and decreased extension at IP joints of ring and little finger

Paralysis of all interosseous muscles- ‘metacarpal guttering’

Sensory loss:
Palmar part of little finger & half of fingers

32
Q

What is forments test?

A

Patient can’t hold on to the paper with adductor muscle, but FPL and FPB are intact (median) which allows for h9lding on by flexing the interphalangeal joint of the thumb

33
Q

What is the origin of the axillary nerve?

A

From posterior cord

34
Q

What is the course of the axillary nerve?

A
  • Passes inferiorly and laterally to exit through the quadrangular space accompanied by the posterior humeral circumflex artery
  • Passes posterior to the surgical neck of humerus
35
Q

What are the motor and Sensiry supply of the axillary nerve?

A

Motor supply: supplies deltoid and teres minor

Sensory supply: upper lateral part of arm

36
Q

What are signs & symptoms of injury to axillary nerve

A
  • decreased lateral rotation
  • decreased abduction
  • loss of sensation to the lateral shoulder

Musculoskeletal System (41 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions