Clinical Correlations Flashcards
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.
